What Is the HCPCS for Prostate Exams?

The Healthcare Common Procedure Coding System (HCPCS) is a standardized coding system made up of two parts. Part one includes Current Procedural Terminology (CPT) codes for medical procedures, such as prostate exams.

Purpose

• HCPCS codes are used by Medicare and other health insurers to process payment claims in an orderly and consistent fashion that expedites claims approval and reimbursement to the healthcare provider.

Types

• When a healthcare provider is screening a man for prostate cancer, he will utilize two diagnostic procedures: a digital rectal exam and a blood test known as prostate-specific antigen (PSA).

Identification

• The HCPCS code for a digital rectal exam is G0102, and the code for the PSA test is G0103.

Considerations

• Male Medicare beneficiaries are covered for an annual digital rectal exam and PSA test beginning at age 50.

Tip

• There are a number of commercial software systems that help billing personnel identify HCPCS codes quickly and accurately.