Prostate cancer screenings can detect prostate cancer in its early stages.
Medicare Part B covers one annual prostate cancer screening for individuals age 50+. The prostate screening includes:
- A digital rectal exam (DRE)
- And, a prostate-specific antigen (PSA) test
Medicare also covers diagnostic prostate cancer screenings. Your provider may recommend that you receive a prostate cancer screening more than once per year, depending on your medical need.
If you qualify, Original Medicare covers preventive prostate cancer screenings at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover prostate cancer screenings without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
Diagnostic prostate cancer screenings are covered at 80% of the Medicare-approved amount. When you receive the service from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible. If you are enrolled in a Medicare Advantage Plan, your plan’s cost and coverage rules apply when receiving diagnostic screenings.
During the course of your screening, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.
Note: Some cancer screenings and other services are associated with specific genders in Medicare materials and rules but are covered regardless of the gender marker in your Social Security record, as long as the screening is clinically appropriate for you. Medicare has specific billing modifiers that your provider should use when submitting claims for services when the gender marker on your Social Security record could cause an incorrect coverage denial.