Does Medicare Cover 4Kscore? 

The prostate is a male gland below the bladder in front of the rectum. The gland secretes fluid that conjoins with semen to maintain healthy sperm. When cancer develops in the gland, treatments can range from active surveillance to surgery, depending on how fast the tumor grows.

The American Cancer Society predicts that about one in eight men will receive a prostate cancer diagnosis at some point. The average age of a first diagnosis is about 66 years old. According to the Cleveland Clinic, prostate cancer is often curable with early detection and treatment. 

Prostate cancer detection

The prostate-specific antigen (PSA) blood test measures the level of PSA in your blood. An antigen is a substance that prompts your body to generate antibodies, which your immune system produces to protect you from invaders. High PSA levels may be a sign of cancer, but this blood test is only one component of the screening process.

Generally, a physician will order both a PSA test and a digital rectal exam (DRE). During a DRE, your doctor can feel if the shape or thickness of your prostate gland is abnormal. If screening test results indicate prostate issues, your doctor may order a prostate biopsy to remove and examine tissue for cancer detection. 

A grading system pathologists use to denote the cancer stage is called a Gleason score. According to the National Center for Biotechnology Information (NCBI), many men with a low Gleason score have unnecessary prostate biopsies and overtreatment. A tumor that is not life-threatening may only require monitoring. 

The 4Kscore Test

The 4Kscore (prostate-specific kallikrein) Test projects the likelihood of an aggressive form of prostate cancer. Blood test results measuring the concentration of four biomarkers are combined with specific data (age, biopsy records, and DRE results) to create an algorithm. 

The number generated represents the probability that your prostate cancer is life-threatening. With this information, you and your physician can develop a personalized treatment plan and decide whether or not a biopsy is the appropriate course of action in your case. 

Medicare coverage for prostate cancer screenings

Medicare Part B includes several preventive services, including prostate cancer screenings. Male Medicare beneficiaries are eligible for annual DREs and PSA tests as of the day following their 50th birthday. Your out-of-pocket expense for the DRE is the Part B deductible and 20% coinsurance. A hospital outpatient facility may also require a copayment. There is no cost to you for the PSA test.

Medicare may cover a 4Kscore Test if it is medically reasonable and necessary. The test must include blood level measurements for all four kallikreins proteins. The physician has to present DRE results, clinical information, biopsy history and evidence of physician-patient joint decision-making concerning the 4Kscore procedure.

Prostate cancer and the 4KScore Test

The Urology Care Foundation, American Cancer Society and Mayo Clinic are authoritative organizations providing details about the causes, symptoms, screenings and treatments for prostate cancer. The BioReference Laboratories website includes a link to information and resources specific to the 4KScore Test.

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