| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
G0103 |
| HCPCS Sequence Number |
0010 |
| HCPCS Record Identification Code |
3 - First line of procedure record also contains detail information in positions 92-275 |
| HCPCS Long Description |
Prostate cancer screening; prostate specific antigen test (psa) |
| HCPCS Short Description |
Psa screening |
| HCPCS Pricing Indicator Code 1 |
21 - Price subject to national limitation amount |
| HCPCS Multiple Pricing Indicator Code |
A - Not applicable as HCPCS priced under one methodology |
| HCPCS Coverage Issues Manual Reference Section Number 1 |
50-55 |
| HCPCS Medicare Carriers Manual Reference Section Number 1 |
4182 |
| HCPCS Lab Certification Code 1 |
310 - Routine chemistry |
| HCPCS Coverage Code |
D - Special coverage instructions apply |
| HCPCS Processing Note Number |
0064 |
| HCPCS Berenson-Eggers Type Of Service Code |
T1H - Lab tests - other (non-Medicare fee schedule) |
| HCPCS Type Of Service Code 1 |
5 - Diagnostic laboratory |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
1/1/2000 |
| HCPCS Action Effective Date |
1/1/2007 |
| HCPCS Action Code |
N - No maintenance for this code |