Molecular Biomarkers for Prostate Cancer Risk Stratification - Medicare Advantage

This policy covers molecular diagnostic tests and laboratory‑developed tests for prostate cancer risk stratification used to assess risk of clinically significant prostate cancer and to guide initial or repeat biopsy decisions. Coverage is limited to men meeting specified clinical criteria (eg, ages 45–75 with PSA 3–10 ng/mL, >75 with PSA 4–10 ng/mL, or a very suspicious DRE), and tests are reimbursed only if they demonstrate clinical utility and either have a MolDX technical assessment approval or FDA approval/clearance within labeling; jurisdictional LCDs govern coverage and investigational or non‑indicated tests (eg, ArteraAI) are excluded.

"MoIDX: Defining panel services in MoIDX (title indicates definition/coverage considerations for panel services in MoIDX)."

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