G0103 — Prostate cancer screening; prostate specific antigen test (psa)
G0103 is a HCPCS Level II code for prostate cancer screening; prostate specific antigen test (psa). It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of G0103 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1 unit MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
- outpatient
- 1 unit MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for G0103
- Long descriptor
- Prostate cancer screening; prostate specific antigen test (psa)
- Short descriptor
- Psa screening
- Added
- January 1, 2000
- BETOS
- T1H
- Pricing indicator
- 21 — Clinical lab fee schedule
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Price subject to the national limitation amount.
Codes adjacent to G0103
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G0103 is not quite right, the correct code is very often within a few positions of it.
- G0085Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
- G0086Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
- G0087Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
- G0088Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes
- G0089Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
- G0090Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
- G0101Cervical or vaginal cancer screening; pelvic and clinical breast examination
- G0102Prostate cancer screening; digital rectal examination
- G0104Colorectal cancer screening; flexible sigmoidoscopy
- G0105Colorectal cancer screening; colonoscopy on individual at high risk
- G0106Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enematerminated
- G0108Diabetes outpatient self-management training services, individual, per 30 minutes
- G0109Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
- G0117Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
- G0118Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
- G0120Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.terminated
Questions about G0103
What is HCPCS code G0103?
G0103 is a HCPCS Level II code for prostate cancer screening; prostate specific antigen test (psa). It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G0103?
The CMS HCPCS file marks G0103 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is G0103 paid under the physician fee schedule?
G0103 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.