Question: A patient undergoes prostate cancer screening in my practice. On the claim, I reported V76.44 for diagnosis, and G0103 for the screening service. Yet, I got denied. Why?
Tennessee Subscriber
Answer: Code V76.44 (Special screening for malignant neoplasms, prostate) supports G0103 (Prostate cancer screening; prostate specific antigen test [PSA]). Go back and check your HCPCS code. Remember, the two most common screenings used by physicians to detect prostate cancer are DRE and PSA blood tests. They are represented with G0102 (Prostate cancer screening; digital rectal examination) and G0103.
A payer may deny coverage of the annual preventive prostate cancer screening services for several reasons: