Early Prostate Cancer Detection - Medicare Advantage

Covers early prostate cancer detection services for Medicare Advantage members — including PSA testing (total, free/complexed), digital rectal exam, molecular biomarkers, gene-expression profiling, molecular diagnostic tests and related genetic testing used for screening and risk stratification. Applicable to men undergoing baseline or surveillance screening (including those with hereditary cancer risk), coverage is governed by the applicable MAC/NCD/LCD (jurisdiction-specific, e.g., MoIDX L36807/LCA A57772), requires tissue biopsy to confirm diagnosis, and is subject to the detailed frequency, age, and clinical criteria in the underlying MAC/NCD LCDs; PSA specificity may be reduced by noncancerous conditions such as BPH.

"Coverage follows the applicable Medicare Administrative Contractor's (MAC's) Local Coverage Determination (LCD) for requests (both Part A and Part B services) within the MAC's applicable geographic..."