Prostate Biopsy Specimen Analysis Payment Policy
Defines Blue KC's payment and coverage stance for pathological examination of prostate biopsy specimens (including limits on saturation biopsies and vialization) for applicable lines of business and provider types.
Initial version published (Version 001).
Coverage Criteria for Prostate Biopsy Specimen Analysis
Coverage criteria for prostate biopsy specimen analysis
Coverage is conditional based on benefit coverage and clinical context.
ALL of the following
ONE of the following clinical indications
- Initial diagnosis: pathological examination of tissue obtained from a prostate biopsy involving 12-core extended sampling may be reimbursable as a follow-up to abnormal PSA results.
- Initial diagnosis: pathological examination of tissue obtained from a prostate biopsy involving 12-core extended sampling may be reimbursable for presence of a palpable nodule on digital rectal examination.
- Initial diagnosis: pathological examination of tissue obtained from a prostate biopsy involving 12-core extended sampling may be reimbursable for suspicious radiologic findings.
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