Does Medicare Cover a Prostate Specific Antigen (PSA) Test?
- Get the facts about Medicare coverage for the prostate specific antigen (PSA) test. Find out when and how frequently Medicare will pay for prostate cancer screening.
Prostate cancer ranks second only to skin cancer as a leading type of cancer in men. Approximately one in every eight men will develop prostate cancer at some point during their lives, according to the American Cancer Society. Early detection can greatly improve the chances of successful treatment, making prostate cancer screenings, such as the prostate-specific antigen test or PSA, important. Medicare typically pays for these tests. Read on to learn more.
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What Is the Screening Test for Prostate Cancer?
The PSA test is the primary screening test for prostate cancer. To perform the test, a medical professional collects a blood sample and sends it to a lab for analysis. The test measures how much of a substance called prostate-specific antigen is present in the blood.
What Does a High PSA Level Mean?
Healthy cells in the prostate produce limited amounts of prostate-specific antigen. When prostate problems occur, the cells increase production, leading to elevated PSA levels. A high PSA level may indicate:
- Prostatitis (inflammation of the prostate)
- Benign prostatic hyperplasia (prostate enlargement)
- Prostate cancer
If your PSA levels are high, your doctor will likely order additional diagnostic tests to determine the cause.
How Is a Digital Rectal Exam Different From a Prostate-Specific Antigen Test?
A digital rectal exam is when a doctor inserts his finger into your rectum to feel your prostate for signs of enlargement. A prostate-specific antigen test is a blood test that measures how much PSA is present in your blood. Often, doctors use both digital rectal exams and PSA testing to screen for prostate cancer.
What Is the Cost of a PSA Blood Test?
The cost of a PSA blood test varies based on where you live, but the American Board of Internal Medicine Foundation reports that the average cost of the test is $40. Your doctor may charge an additional fee or copayment for the office visit. If your PSA levels are elevated, you are likely to have additional costs for further testing. The average prices for common tests are:
- Up to $350 for consultation fees
- $150 for ultrasounds
- Up to $200 for professional fees
- $500 for biopsies
Does Medicare Cover a PSA Test Cost?
Medicare Part B usually covers 100% of a PSA test for annual testing for men aged 50 and over. If your doctor assesses additional fees, Medicare Part B typically covers 80% of the costs, leaving you responsible for the remaining 20%. You may also be responsible for a copay.
Does Medicare Pay for Prostate Cancer Screenings?
In addition to paying for the PSA test, Medicare Part B will cover 80% of the cost of annual digital rectal examinations and additional fees assessed by your doctor. You are also likely to be assessed a copay.
At What Age Does Medicare Start Paying for the PSA Test?
For most men, Medicare begins paying for PSA testing at age 50. If your doctor believes that the test is medically necessary due to symptoms you are experiencing or a family history of prostate cancer, Medicare may cover the cost of a PSA test before you turn 50.
Do Medicare Advantage Plans Pay for the Prostate-Specific Antigen Tests?
Medicare Advantage plans must cover at least as much as what Medicare does. If your doctor assesses fees for diagnostic testing based on the results of your PSA test results, Medicare Advantage will usually pay for those additional expenses while Medicare Part B pays for the initial PSA test.
Do Medigap Plans Pay for the Prostate-Specific Antigen Tests?
Medigap plans pay for the 20% of health care costs not covered by Medicare Part B. With PSA testing, your Medicare Part B plan pays for the blood work, but Medigap will usually cover the remaining costs for fees and other diagnostic tests that Medicare doesn't provide payment for.
How Often Will Medicare Pay for PSA Testing?
Generally, Medicare will pay for one PSA test each year. If your doctor believes it is medically necessary for you to undergo PSA testing more frequently, Medicare may cover the cost.
What Is a PSA Medicare Screen Versus a PSA Medicare Diagnostic?
On a Medicare statement, a PSA Medicare screen is routine PSA testing performed annually to check for signs of prostate cancer. Most often, PSA tests fall under this category. A PSA Medicare diagnostic test is ordered by a doctor due to a suspicion that a person may have prostate cancer. For example, if you made an appointment to discuss difficulty urinating and your doctor ordered a PSA test to check your prostate, the blood work would likely be classified as diagnostic.