CPT CODE G0102, G0103, G0101 - covered ICD 10 codes

Prostate Cancer Screening

HCPCS/CPT Codes

G0102 – Digital Rectal Exam (DRE)
G0103 – Prostate Specific Antigen Test (PSA)

ICD-10-CM Codes
Z12.5

Who Is Covered
All male Medicare beneficiaries aged 50 and older (coverage begins the day after their 50th birthday)

Frequency
Annually for covered beneficiaries


Beneficiary Pays

G0102:

• Copayment/coinsurance applies

• Deductible applies
G0103:
• Copayment/coinsurance waived
• Deductible waived

Screening Pelvic Examinations (includes a clinical breast examination)

HCPCS/CPT Codes

G0101 – Cervical or vaginal cancer screening; pelvic and clinical breast examination


ICD-10-CM Codes

High risk – Z77.22, Z77.9, Z91.89, Z72.89,
Z72.51, Z72.52, AND Z72.53

Low risk – Z01.411, Z01.419, Z12.4, Z12.72,
Z12.79, and Z12.89

Who Is Covered

All female Medicare beneficiaries

Frequency

• Annually if at high risk for developing cervical or vaginal cancer, or childbearing age with abnormal Pap test within past 3 years; or

• Every 2 years for women at normal risk

Beneficiary Pays

• Copayment/coinsurance waived
• Deductible waived