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HCPCS G0103 · Level II · G code

G0103: Prostate cancer screening; prostate specific antigen test (PSA), HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); Clinical Laboratory Fee Schedule: 26CLABQ4 (CY2026 Q4) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and Clinical Laboratory Fee Schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G0103

Medicare payment
$19.31
CLFS national limitation amount
Coverage code
D
special coverage instructions apply
Practitioner MUE
1
MAI 2
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
6
6 hospital outpatient
LCDs and articles
0 / 0

TL;DR

HCPCS Level II G0103 reads "Prostate cancer screening; prostate specific antigen test (psa)" in the October 2026 file; it dates from 2000. The 2026 Q4 clinical laboratory fee schedule pays G0103 $19.31 (national limitation amount). CMS caps G0103 at practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0103 appears in 2 practitioner pairs as column 2 and 4 as column 1 (most often with 0403U, 0495U), and in 2 hospital outpatient pairs as column 2 and 4 as column 1. G0103 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS T1H (lab tests - other (non-Medicare fee schedule)); pricing indicator 21; type of service 5 (diagnostic laboratory). 1 other active code opens with "Prostate cancer screening"; related codes: G0102, G0104, G0101, G0105.

G0103 descriptor and code status

The October 2026 HCPCS Level II file describes G0103 as “Prostate cancer screening; prostate specific antigen test (psa)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0103 CPT code", G0103 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0103
FieldValue
Short descriptorPsa screening
Added to HCPCS2000-01-01
Last actionN (no maintenance), effective 2007-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator21: clinical lab fee schedule, subject to the national limitation amount
BETOS categoryT1H: lab tests - other (non-Medicare fee schedule)
Type of service5: diagnostic laboratory

Medicare payment for G0103

The 2026 Q4 clinical laboratory fee schedule pays G0103 $19.31 (national limitation amount). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Clinical Laboratory Fee Schedule (26CLABQ4)

G0103 is paid at $19.31 (national limitation amount). Laboratory fee schedule payments carry no beneficiary coinsurance or deductible.

Hospital outpatient (OPPS Addendum B)

Status indicator A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for G0103

CMS caps G0103 at practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0103 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyAnatomic Consideration
Facility outpatient hospital12 Date of Service Edit: PolicyAnatomic Consideration

The MUE lookup for G0103 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0103 is the column-2 (bundled) code in 2 active pairs, 100% of which allow a modifier and the column-1 code in 4 (25% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with G0103 (practitioner)
Column-1 codePairs
0403U (CPT; descriptor licensed by AMA)1
0495U (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into G0103 (practitioner)
Column-2 codePairs
0424U (CPT; descriptor licensed by AMA)1
0433U (CPT; descriptor licensed by AMA)1
84153 (CPT; descriptor licensed by AMA)1
84154 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0103 is the column-2 (bundled) code in 2 active pairs, 100% of which allow a modifier and the column-1 code in 4 (25% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with G0103 (hospital outpatient)
Column-1 codePairs
0403U (CPT; descriptor licensed by AMA)1
0495U (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into G0103 (hospital outpatient)
Column-2 codePairs
0424U (CPT; descriptor licensed by AMA)1
0433U (CPT; descriptor licensed by AMA)1
84153 (CPT; descriptor licensed by AMA)1
84154 (CPT; descriptor licensed by AMA)1

G0103 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check G0103 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0103

No current LCD or billing and coding article lists G0103. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on G0103

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of G0103 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0103 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0103 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0103

What does HCPCS code G0103 describe?

"Prostate cancer screening; prostate specific antigen test (psa)" (short descriptor "Psa screening"), in the G section (procedures and professional services, temporary). Added 2000-01-01; last action N (no maintenance) effective 2007-01-01.

Is G0103 a CPT code?

It is not. G0103 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT. "G0103 CPT code" searches refer to it.

What does Medicare pay for G0103?

The 2026 Q4 clinical laboratory fee schedule pays G0103 $19.31 (national limitation amount).

How many units of G0103 can be billed per day?

CMS caps G0103 at practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0103?

G0103 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.