Medicare has announced expanded coverage of Prolaris.

Now patients with Medicare at NCCN favorable intermediate-risk have Medicare coverage, in addition to very low- and low-risk. (MolDX LCD IDs: L36350 and L37082).

NCCN Favorable Intermediate Risk:

  • Patient is Intermediate Risk:
    • Clinical tumor stage T2b or T2c, OR
    • Gleason score 7, OR
    • PSA 10-20ng/mL
  • Meets Only ONE Intermediate Risk Factor
  • Gleason Score 3+4=7 or less
  • Less than 50% Positive Cores

Have you completed the MEDICARE MANDATED CERTIFICATION AND TRAINING to get access for your patients?

If no, please enroll now to get coverage access for your patients with Medicare.

If yes, no additional action is needed. Adverse event (death or metastasis) reporting is required for NCCN very low-, low- and favorable intermediate-risk patient with a low Prolaris score.

Medicare patients at unfavorable intermediate- and high-risk can still receive Prolaris testing when the ordering provider decides it is appropriate. These patients may be eligible to participate in a prospective clinical registry that will require no out-of-pocket costs when the physician is enrolled in the Prolaris CTR program.

Prolaris LCD for NCCN very low- and low-risk

Prolaris LCD for NCCN favorable intermediate risk

Learn more about Prolaris

Press Release

Medicare Expanding Coverage of Prolaris