PSE test is FDA approved and covered by Medicare

PSMA PET scans are always covered unless they want to give You are a hard time.

Decipher has been covered by Medicare and other insurance companies

@happydappy
In answers to your questions to me.
Medicare does cover Decipher, PSMA, bone scans, and second opinons. That I can pass on from my own experience with my own insurance. I am not sure who you were seeing but would think they would have a billing department that could advise you about insurance that you have.

I also have BCBS FEP which also covers Decipher, bone scans, PSMA, second opinions. I cannot speak for all insurance but gave you my experience with the ones I have.

Regarding recommendations. I was at Mayo Jacksonville when I had my biopsies and consultation with R/O. It was the Mayo R/O that suggested doing a Decipher test, and bone scan. I did not ask for those test. I was not aware of what a Decipher test was nor was I on MCC (back in January of 2023).

My opinion is that any good and careful R/O, urologist would want a Decipher test done. But I think (I am not a medical professional and should not give medical advise) there are certain times a urologist or R/O is dealing with a scenario that are specific to your case.

It seems from your explanation of your case that you have a low level Gleason score (was it 3+3=6) if so what they told you about active surveillance seems to be the norm I am reading on MCC. It is is higher would suggest second opionin on the active surveilance.

But I want to add again I am not a medical professional and just commenting on what I am reading from other posters. None of us should give you diagnosis or what specific treatment you should get that is up medical professionals and your specific case.

You did not asked about second opinions which I highly recommend as well a most other MCC participants in that it can help you decide on accuracy of your diagnosis and the appropriate treatments.

When I went for second opinion at UFHPTI they wanted to do a PSMA to the add to the Decipher and bone scan done at Mayo. Insurance paid and there was no discussion about need to do it by R/O, he ordered it and said wanted to see results of PSMA.

Hope I was able to answer your questions @happydappy. I am unfamiliar with the numbers when used for Decipher test. My score was given to me as low risk versus my biopsies had me at intermediate.