Prostate Cancer Screening

PSA screening is covered as a preventive service for average‑risk men ≥45 and for high‑risk men (African‑American or family history) ≥40, for annual screening after previously elevated PSAs or with signs/symptoms, and for follow‑up of prostate cancer; routine screening is not medically necessary for men ≥75 unless life expectancy ≥10 years, and numerous non‑PSA biomarkers/genetic tests (e.g., PCA3, TMPRSS2:ERG, hK2, selenium assays, Apifiny) and listed CPT codes are considered experimental/investigational and not covered. Check individual benefit plans for preventive service exclusions and apply the age/risk and life‑expectancy requirements above.

"The following for prostate cancer screening because they have no proven value for this indication (not an all-inclusive list): Endoglin."

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