Medicare does cover a PSA test. Part B pays the full cost of one prostate-specific antigen screening blood test every 12 months for men 50 and older, provided the doctor, nurse practitioner, physician assistant, or clinical nurse specialist managing your care orders it and the provider accepts Medicare assignment.1Centers for Medicare & Medicaid Services. National Coverage Determination 210.1 – Prostate Cancer Screening Tests2Medicare.gov. Prostate Cancer Screenings The test you expect to be free can still generate a bill, though, and the reason is almost always the same: how it was coded.
The Annual Screening Is Free
At least 11 months must pass after your last Medicare-covered PSA screening before the next one qualifies.1Centers for Medicare & Medicaid Services. National Coverage Determination 210.1 – Prostate Cancer Screening Tests When the blood draw is billed as a routine screening and your provider accepts assignment, you pay nothing, no deductible and no coinsurance.2Medicare.gov. Prostate Cancer Screenings This is the standard rule for most Medicare preventive services delivered by an assignment-accepting provider.3Medicare.gov. Preventive Screening Services
One boundary worth noting: the digital rectal exam Medicare also covers once every 12 months is not free. You pay 20% of the Medicare-approved amount for the DRE after the Part B deductible ($283 in 2026).2Medicare.gov. Prostate Cancer Screenings4Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
Screening PSA vs. Diagnostic PSA
This is where the surprise bills come from. A screening PSA is a routine check with no symptoms involved. A diagnostic PSA is ordered because you have symptoms like difficulty urinating, blood in urine, or a previously abnormal result. Same blood draw, different billing code, very different cost.
When the test is coded diagnostic, standard Part B cost-sharing applies. You pay the $283 annual deductible if you haven’t already met it for the year, then 20% coinsurance on the Medicare-approved amount.4Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles If your doctor is ordering the test because you reported symptoms, ask upfront whether the lab will code it as diagnostic. Knowing in advance lets you plan for the cost instead of being surprised weeks later.
What You Actually Pay
Your out-of-pocket cost depends on the type of test and whether your provider accepts assignment. Providers who accept assignment agree to charge only the Medicare-approved amount for covered services.5Medicare.gov. Provider Accept Medicare
- Screening PSA blood test: $0 when your provider accepts assignment.
- Screening DRE: 20% coinsurance after the $283 Part B deductible.
- Diagnostic PSA blood test: 20% coinsurance after the Part B deductible.
If your provider does not accept assignment, you could be charged up to 15% above the Medicare-approved amount on top of regular cost-sharing. For the screening PSA, Medicare still covers the test itself, but the provider can bill an additional fee for the office visit or blood draw service.2Medicare.gov. Prostate Cancer Screenings
Medicare Advantage and Medigap
Medicare Advantage plans must cover the annual PSA screening and DRE under the same eligibility rules as Original Medicare.2Medicare.gov. Prostate Cancer Screenings The screening PSA should still cost you $0 under preventive coverage rules. What changes is the structure around it: your plan may require an in-network lab, a referral before you see a urologist, or a flat copay instead of percentage coinsurance for anything beyond the screening. Check your plan’s Evidence of Coverage for the specifics.
If you have Original Medicare plus a Medigap policy, your exposure on non-screening services shrinks. Medigap doesn’t come into play for the screening PSA itself because that test is already free. Where it helps is with the DRE, diagnostic PSA tests, and follow-up procedures. Most Medigap plans cover the 20% Part B coinsurance, and some also cover the Part B deductible. Plans K and L cover coinsurance at 50% and 75% respectively until you hit an annual out-of-pocket limit, after which coverage jumps to 100%.6Medicare.gov. Compare Medigap Plan Benefits Medigap policies are not available to Medicare Advantage enrollees.
Costs After an Abnormal Result
An elevated PSA does not mean you have prostate cancer, but it usually means more testing. Follow-up services are billed as diagnostic, not preventive, so standard Part B cost-sharing applies: the annual deductible plus 20% coinsurance on each service.
Common next steps include a repeat PSA at a closer interval, a prostate MRI, or a prostate biopsy. Medicare Part B covers medically necessary diagnostic tests ordered by your provider. For a biopsy performed at an outpatient facility, you would owe 20% of the Medicare-approved amount for both the physician’s services and the facility fee after meeting your deductible. Total costs for a prostate biopsy can run into the thousands before Medicare’s share is applied, so your 20% portion is worth planning for. Medigap picks up most or all of that 20% coinsurance. With a Medicare Advantage plan, your plan’s copay or coinsurance schedule applies instead.
How to Keep the Test Free
The most common reason people pay out of pocket for a test that should be free is a coding mistake. Before your blood draw, confirm with your doctor’s office that the order specifies a routine screening rather than a diagnostic test, assuming you have no symptoms and no prior abnormal results.
Verify that both your doctor and the lab accept Medicare assignment. You can check a provider’s assignment status through Medicare’s online provider directory.5Medicare.gov. Provider Accept Medicare
Track the timing. Medicare covers one PSA per 12-month period with at least 11 months between tests.1Centers for Medicare & Medicaid Services. National Coverage Determination 210.1 – Prostate Cancer Screening Tests A January test followed by a November test in the same year can trigger a denial. Keep a record of test dates so you can confirm eligibility before your next appointment.
If a provider expects Medicare will not pay, most often because the test falls inside the 12-month window or the code doesn’t match Medicare’s coverage criteria, they are required to give you an Advance Beneficiary Notice of Noncoverage before performing it.7Centers for Medicare & Medicaid Services. FFS ABN The ABN tells you the claim is expected to be denied and asks whether you want the service anyway at your own expense. ABN rules apply only to Original Medicare; Advantage plans use their own notification process.8Centers for Medicare & Medicaid Services. Advance Beneficiary Notice of Non-coverage Tutorial If a claim is denied and you believe it shouldn’t have been, you can appeal, and most PSA disputes resolve at the first level when the cause was a coding error.