PSA (Addition of ICD-9-CM 600.21, Benign localized hyperplasia of prostate with urinary obstruction as a covered indication)

CMS received an external request to add ICD-9-CM code 600.21, Benign localized hyperplasia of prostate with urinary obstruction, as a covered indication for the Prostate Specific Antigen (PSA) NCD at 190.31 of the NCD Manual.

The narrative covered indications for the PSA NCD state, “PSA is of proven value in differentiating benign from malignant disease in men with lower urinary tract signs and symptoms as well as with patients with palpably abnormal prostate glands on physician exam and in patients with other laboratory or imaging studies that suggest the possibility of a malignant prostate disorder.”

We believe code 600.21, Benign localized hyperplasia of prostate with urinary obstruction, flows from the narrative.  We are seeking public comment on the addition of code 600.21 to the ICD-9-CM Codes Covered By Medicare list for the PSA NCD.

The regulation for maintaining code lists in the negotiated NCDs for clinical diagnostic laboratory services states that codes on the covered list flow from the existing NCD narratives of covered indication.  The regulation was published February 25, 2005 in the Federal Register, Vol.70, No. 37 and can be viewed at http://www.cms.hhs.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html#TopOfPage.

May 31, 2006

July 17, 2006