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Does Medicare cover prostate cancer screening?


Yes, Medicare covers a couple of screenings and tests, including the prostate specific antigen (PSA) blood test, which measures the PSA level in your blood.

PSA is a protein produced by cells of the prostate gland. Even though cells can produce normal and malignant protein, elevated PSA levels don’t necessarily mean cancer is present.

Prostate cancer is the second most common cancer among men in the United States, after skin cancer. One in 8 men will be diagnosed with prostate cancer during their lifetimes, according to the American Cancer Society.

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Does Medicare cover PSA tests?

Medicare Part B covers a prostate PSA blood test every 12 months for men 50 and older — the majority of Medicare beneficiaries are 65 or older; about 1 in 7 are younger and qualify because of a disability. The PSA test is a free preventive service that isn’t subject to deductibles or coinsurance as long as your doctor or other provider accepts assignment.

While PSA levels can be higher in men who have prostate cancer, an infection, enlarged prostate, certain medications or some medical procedures can also cause elevated PSA levels.

What other prostate screenings does Medicare cover?

Medicare also covers additional screening and tests, including:

Digital rectal exam. With a digital rectal exam, a health care provider inserts a gloved finger into the rectum to feel the prostate for abnormal lumps. Medicare Part B covers one digital rectal exam every 12 months starting at age 50. This test is subject to a Part B deductible and 20 percent coinsurance.

MRI and biopsy. If you have a high PSA level and a suspicious finding in the digital rectal exam, your physician may order additional tests, such as an MRI or biopsy. The provider will also consider other factors in your history before ordering these tests, according to the American Cancer Society.

An MRI is an imaging test physicians use to look for cancer and determine if it has spread. With a biopsy, small samples of the prostate are removed and studied under a microscope. The most common type is a core needle biopsy, in which a urologist inserts a thin needle into the prostate to take about 12 core samples from different areas.

The MRI and biopsy are covered by Part B as diagnostic tests and are subject to a deductible and 20 percent coinsurance.

For more information about the different types of prostate cancer screening and tests, see the American Cancer Society’s guide to Screening Tests for Prostate Cancer.

Keep in mind

The U.S. Preventive Services Task Force recommends that men ages 55 to 69 discuss the potential benefits and harms of PSA testing with their physician before deciding whether to undergo periodic PSA screening. It also recommends against PSA screening for prostate cancer in men 70 and older. While the task force notes that screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men, it also identifies potential harms, including:

  • False-positive results that require additional testing and possible prostate biopsy.
  • Overdiagnosis.
  • Overtreatment.
  • Treatment complications.

Published July 6, 2023

 

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