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Still Leaking after Robotic Surgery: Thoughts on water intake
Prostate Cancer | Last Active: Mar 29 1:22pm | Replies (47)Comment receiving replies
@rlpostrp I did learn the hard way that you never want to sign an ABN(advanced beneficiary notice). The Medical facility/lab submits to Medicare their request for service on one of those 476 codes. In order for the facility to bill you for that service they must have you sign an ABN in advance. My lesson was on a $150 PSA test of all things. Lab Corp wanted me to sign an ABN or pay the $19 cash price. I called Medicare and they said it should be covered if its submitted correctly. However they wont tell you what code. So I signed the ABN then was billed $150. I appealed all the way to a judge. I know that Mayo Phoenix will only take Medicare traditional . I guess the additional restrictions placed by the HMO.
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@tuckerp Anyone can find the "CPT Code" for any test or procedure. Just type in your computer search bar, or "ask Siri", - "What is the CPT Code for a PSA test?" Or "What is the CPT Code for an Ultra-Sensitive PSA Test?" But...to make life easy for you, here are the CPT Codes for the various PSA tests: 84152, 84153, or 84154.
84152 - Prostate Specific Antigen (PSA); complexed (direct measurement)
84153 - Prostate Specific Antigen (PSA); Total ***This is the most commonly performed/billed.
84154 - Prostate Specific Antigen (PSA); Free (a.k.a. "Free PSA").
BTW: CPT stands for "Current Procedural Terminology". Every last test, procedure, or treatment..."anything"...that can be done to your body, your blood, your tissue, etc., has a CPT Code for billing purposes. There is also what is known as ICD-11. It is for coding "diseases." It is an internationally used system. There has been a progression of updates through the many years this has been used. ICD-11 began its use, replacing ICD-10 in January 2022. Before I retired in 2016, ICD-9 was being used. It is reviewed every year, but only updated when enough updates warrants it. Someday there will likely be ICD-39, ICD-52, ICD-74 (unless some other system is developed)...but we'll all be dead and gone by then.
Also, for those having a challenge with getting their Decipher Score test covered, you can do the same thing. The test usually needs prior authorization, but most plans should not have a problem approving it.
Sometimes two codes are offered. The Decipher Test is a genetic screening test for "22" genes. The CPT Code is 81542. There is a separate code 81541 for 46 genes, but that is not for the Decipher Test Score. The CPT Code does not have/use the name "Decipher Score Test" in the CPT Coding book. It is known as "Multianalyte Assay with Algorithmic Analyses" ("MAAA"). In the CPT Book it is further described as: "Oncology (prostate), mRNA microarray gene expression profiling of 22 content genes, utilizing formalin-fixed, paraffin-embedded tissue, algorithm reported as metastasis risk score."
You - any of us - should not have to personally justify reimbursement for either assay with our health plan. Your urologist's office should do that simple work...they have billers and coders who do this "pre-authorization" stuff all day long. If your urologist has not already ordered the Decipher Score test for you, you should ask/demand it. You should just get an e-mail with a hardcopy Pre-Authorization Approval form attached. It should take no more than 1-3 days "max". The test is done on your biopsied tissue, or more often on the tissue from you post-RP surgery so they can send specific tissue from the visibly most-tumorous appearing areas of the prostate. Good luck to all having the CPT challenge. You should not need to be going through this, unless you have no health insurance whatsoever.