4Kscore Test Algorithm
J9 · Effective Mar 18, 2019
21 active Medicare policies list R97.20, and 4 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J9 · Effective Mar 18, 2019
JH · Effective Mar 21, 2019
JL · Effective Mar 21, 2019
J15 · Effective Jul 17, 2022
JE · Effective Aug 8, 2022
JF · Effective Aug 8, 2022
JJ · Effective Jul 3, 2022
JM · Effective Jul 3, 2022
4 policies from 2 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of R97.20 |
|---|---|---|
| Positron Emission Tomography (PET) | Sep 21, 2023 | Covered |
| Prostate Cancer Screening | Jul 14, 2023 | Covered |
| Policy | Effective | Status of R97.20 |
|---|---|---|
| Prostate Specific Antigen Testing | Apr 15, 2026 | Covered |
| Transrectal Ultrasonography | Apr 15, 2026 | Covered |
J5 · Effective Jul 3, 2022
J8 · Effective Jul 3, 2022
J15 · Effective Nov 20, 2022
J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
J9 · Effective Apr 29, 2024
JL · Effective Apr 29, 2024
National · Effective Jun 25, 2026
National · Effective Jun 25, 2026
National · Effective Jun 25, 2026
J5 · Effective Jun 25, 2026
National · Effective Nov 6, 2025
J6 · Effective Apr 1, 2026