@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.