G0103 HCPCS code: Prostate cancer screening; prostate specific antigen test (PSA)
G0103 is the HCPCS Level II code for prostate cancer screening; prostate specific antigen test (PSA). In 2024 Medicare paid an average of $18.88 per service for G0103 across 1,406,946 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume rose 3% from 2022 to 2024 (1,371,602 to 1,406,946 services). In 2024, about 17,265 clinicians billed Medicare for G0103 for 1,406,924 beneficiaries; Texas, North Carolina, Florida accounted for 29% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 21 — Priced on the Clinical Laboratory Fee Schedule |
| BETOS category | T1H |
| Added | 2000-01-01 |
| Last action effective | 2007-01-01 |
Who bills G0103 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 17,265 |
| Medicare beneficiaries | 1,406,924 |
| States with claims | 54 |
| Share of services in top 3 states (Texas, North Carolina, Florida) | 29% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0103, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,371,602 | 1,371,596 | $19.01 | $19.01 |
| 2023 | 1,382,647 | 1,382,635 | $18.87 | $18.87 |
| 2024 | 1,406,946 | 1,406,924 | $18.88 | $18.88 |
States with the most G0103 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 152,037 | $18.90 |
| North Carolina | 133,473 | $18.90 |
| Florida | 117,579 | $18.88 |
| New Jersey | 100,139 | $18.87 |
| California | 90,448 | $18.91 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Anatomic Consideration |
| practitioner claims | 1 | Anatomic Consideration |
What changed for G0103
- 2000-01-01: G0103 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0103?
G0103 is the HCPCS Level II code for prostate cancer screening; prostate specific antigen test (PSA). Short descriptor: "Psa screening".
How much does Medicare pay for G0103?
In 2024, the average Medicare payment was $18.88 per service (average allowed $18.88).
Does Medicare cover G0103?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of G0103 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related G01 codes
- G0101 — Cervical or vaginal cancer screening; pelvic and clinical breast examination
- G0102 — Prostate cancer screening; digital rectal examination
- G0104 — Colorectal cancer screening; flexible sigmoidoscopy
- G0105 — Colorectal cancer screening; colonoscopy on individual at high risk
- G0106 — Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema
- G0108 — Diabetes outpatient self-management training services, individual, per 30 minutes
- G0109 — Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
- G0117 — Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
- G0118 — Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
- G0120 — Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.
- G0121 — Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
- G0122 — Colorectal cancer screening; barium enema
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under G0103
- Watch G0103 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0103
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.