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Test Code PSA (Diag)/PSCRN (Screen) Prostate-Specific Antigen (PSA), serum

Important Note

Please note:  Due to differences in assay methods and reagent specificity, PSA patient results may vary between manufacturers.

Performing Laboratory

MaineGeneral Medical Center

Specimen Requirements

This test may require an advanced beneficiary notice.

Draw blood in a gold-top (serum separater) gel tube. For pediatric specimens, draw blood in a red-top MICROTAINER(S)®. Label the specimen with the patient's name (first and last), date of birth, date and time of draw and the phlebotomist's initials. Spin down and send 1 mL of serum refrigerated.

*Specimen should be drawn prior to prostatic/rectal examination or 24 to 48 hours after examination.

 

Specimen stability:

8 hours at room temperature

2 days refrigerated at 2-8°C

Freeze at ≤ -20°C for longer storage

 

Minimum volume:

1 mL

 

Specimen rejection criteria:

Samples stored at room temperature longer than 8 hours will be rejected.

 

Day(s) Test Performed

Monday - Friday

Test Classification and CPT Coding

G0103 - PSA screening (Z12.5)

84153 - PSA diagnostic

Note:  This test, when ordered on Medicare patients, is subject to the CMS Medicare Coverage Issues Manual (MCIM), Diagnostic Services policy “Prostate Specific Antigen (Diagnostic).”  Please verify that the diagnosis code (ICD-10) you have chosen demonstrates medical necessity for the test as documented in the physician’s patient record. A properly executed Advance Beneficiary Notice (ABN) must be submitted with the specimen if medical necessity is not demonstrated by the ICD-10 code chosen.

Reference Values

0-4.0 ng/mL

Methodology

Chemiluminescent Immunoassay