Medicare Eligibility Criteria
Effective from 1st November 2023, the MBS requirements for prostate-specific antigen (PSA) testing have changed. The new items better align with the NHMRC-endorsed guidelines put forward by the Prostate Cancer Foundation of Australia and the Cancer Council of Australia in 2016.1
The general recommendation is for those men who decide to have PSA tests to assist in the early detection of prostate cancer to have a PSA blood test every two years from age 50 to 69 years.
New items
PSA
66655
PSA quantitation
For any particular patient, applicable not more than once in 23 months.
66654
PSA quantitation in the monitoring of high-risk patients
For any particular patient, applicable not more than once in 11 months.
66656
PSA quantitation in the monitoring of previously diagnosed prostatic disease (including prostate cancer, prostatitis or a premalignant condition such as atypical small acinar proliferation).
Free PSA Percentage
66659
in the follow up of a PSA result under item 66654 or 66655 that lies at:
(a) more than 2.0 ug/L but less than or equal to 5.5 ug/L for patients with a family history of prostate cancer; or
(b) more than 3.0 ug/L but less than or equal to 5.5 ug/L for patients who are at least 50 years of age but under 70 years of age; or
(c) more than 5.5 ug/L but less than or equal to 10.0 ug/L for patients who are at least 70 years of age
For any particular patient, applicable not more than once in 11 months.
66660
in the monitoring of previously diagnosed prostatic disease, including, if performed, a test described in item 66656, if the current PSA level lies at:
(a) more than 2.0 ug/L but less than or equal to 5.5 ug/L for patients with a family history of prostate cancer; or
(b) more than 3.0 ug/L but less than or equal to 5.5 ug/L for patients who are at least 50 years of age but under 70 years of age; or
(c) more than 5.5 ug/L but less than or equal to 10.0 ug/L for patients who are at least 70 years of age
For any particular patient, applicable not more than 4 times in 11 months.
References
1. See ‘PSA-Testing-Guidelines.pdf’ (pcfa.org.au): https://www.pcfa.org.au/media/612113/PSA-Testing-Guidelines.pdf