Forum - Questions & Answers

May 28th, 2010 - barterco

Prostate Specific Antigen (PSA)

My question involves the pairing of a screening PSA (G0103) with a free PSA (84154). Evidently, a modifier is needed but the NCCI will not accept modifier 59 for this code pair.

If I understand correctly, free PSA testing (84154) is permitted on men with a screening PSA level between 4.0 – 10.0 ng/ml “who are being considered for biopsy” (from an old, discontinued LCD). How do you meet the requirements for billing of a free PSA on these patients? Would the physician have to document that the patient is being considered for biopsy in the medical record? Which modifier, if any, do you use when billing for both a screening PSA and a free PSA? Any assistance would be greatly appreciated.

May 28th, 2010 - nmaguire   2,606 

example

https://www.msbcbs.com/medadvpolicy/L-52-004.html

May 30th, 2010 -

remember

it is no longer a screening test- it is being done in response to an abnormal result- use 790.93 linked to the free PSA.



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