LCDActive
ProMark® Risk Score
L36665
Effective: December 30, 2021
Updated: December 31, 2025
Policy Summary
This policy provides limited coverage of the ProMark® test for patients with early-stage, needle biopsy–proven prostate cancer to assist in identifying candidates for conservative (active surveillance) management rather than definitive surgery or radiation. No other indications, documentation, limitations, or frequency limits are specified in the policy text.
Coverage Criteria Preview
Key requirements from the full policy
"ProMark is covered for patients with early-stage, needle biopsy–proven prostate cancer to help determine suitability for conservative (active surveillance) management instead of definitive surgery ..."
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