Billing and Coding: Prostate Cancer Detection with IsoPSA™

IsoPSA should be billed using CPT 0359U for prostate-related diagnostic evaluation with an appropriate ICD-10-CM diagnosis that best describes the patient's condition. Claims must include required documentation (assessment, PSA results or symptoms, signed visit/operative notes, biopsy risk factors, referring provider NPI when applicable), and ABN/modifier rules (-GA, -GX, -GZ, -GY) must be followed; lack of a valid ICD-10 will cause claim return and certain ABN modifiers will trigger automatic denials. The test is not subject to MolDx technical assessment or DEX Z-code requirements.

"Bill IsoPSA using CPT 0359U for prostate cancer detection or evaluation of prostate-related indications when performed per local coverage policy and supported by an appropriate ICD-10-CM diagnosis ..."

Sign up to see full coverage criteria, indications, and limitations.