Changes to PSA Testing under the Medicare Benefits Schedule from 1 November 2023
1. Revised Frequency for Routine Prostate Disease Testing
For patients without an elevated risk of prostate cancer (based on family history), the frequency of PSA testing has been extended from once every 12 months to once every 23 months.
2. Introduction of New Item for High-Risk Patients
Patients with a strong family history (i.e., a first-degree relative diagnosed with prostate cancer) are now eligible for a PSA test every 11 months.
3. Updated Criteria for Percentage Free PSA Testing Following an Abnormal PSA Result
Eligibility for free PSA testing, based on age and family history, is now determined by the following PSA ranges:
– Ages 50 to 69 years: PSA levels >3.0 µg/L but ≤5.5 µg/L
– Patients with a significant family history: PSA levels >2.0 µg/L but ≤5.5 µg/L
When ordering a total and/or free PSA test, it is essential to indicate whether the patient is at an increased risk of prostate cancer (such as having a strong family history or previously elevated PSA levels) or has a known prostate condition. Providing this information ensures that the appropriate Medicare item numbers are applied for accurate billing.
If these clinical details are not supplied, or if the patient does not meet the eligibility criteria under the new Medicare items, a private bill may be issued.
