Question: Which ICD-9 Codes will Medicare allow as showing medical necessity for the PSA test?
Oregon Subscriber Answer: According to Medicare's latest national coverage determination (NCD), the following ICD-9 codes support medical necessity for the prostate specific antigen (PSA) test, code 84153 (Prostate specific antigen [PSA]; total):
185 - Malignant neoplasm of prostate
188.5 - Malignant neoplasm of bladder neck
196.5-196.8 - Secondary malignant neoplasm, lymph nodes
198.5 - Secondary malignant neoplasm, bone and bone marrow
198.82 - Secondary malignant neoplasm, genital organs
233.4 - Carcinoma in situ, prostate
236.5 - Neoplasm of uncertain behavior of prostate
239.5 - Neoplasm of unspecified nature, other genitourinary organs
596.0 - Bladder neck obstruction
599.6 - Urinary obstruction, unspecified
599.7 - Hematuria
600.01 - Benign prostate hypertrophy with urinary obstruction
601.9 - Unspecified prostatitis
602.9 - Unspecified disorder of prostate
788.20-788.21 - Retention of urine
788.30 - Urinary incontinence, unspecified
788.41 - Urinary frequency
788.43 - Nocturia
788.62 - Slowing of urinary stream
788.63 - Urgency of urination
790.93 - Elevated prostate specific antigen
793.6-793.7 - Nonspecific abnormal result of radiologic examination, evidence of malignancy
794.9 - Bone scan evidence of malignancy
V10.46 - Personal history of malignant neoplasm; prostate.
For the complete NCD information, go online to
www.cms.hhs.gov/coverage/manual7.pdf.
