G0103 Psa screeningProstate cancer screening; prostate specific antigen test (psa)
Status X: statutory exclusion, not paid under the PFS.
0 of 1 payer prior-auth lists that name G0103 require prior authorization or set conditions.
G0103 appears in 6 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Prostate Biopsy (0698) | listed, no stance | Mar 2, 2026 | payer document |
| Aetna | Prostate Cancer Screening (0521) | covered if criteria are met | Aug 28, 2026 | payer document |
| Aetna | Tumor Markers (0352) | covered if criteria are met | Aug 25, 2026 | payer document |
| Anthem | Prostate Specific Antigen Testing (CG-LAB-28) | covered if criteria are met | Feb 19, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Prostate Specific Antigen Psa (L.2.04.419) | listed, no stance | payer document | |
| Premera Blue Cross | Preventive Care Prostate cancer screening | covered if criteria are met | Sep 21, 2026 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.