Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut SURG.00107 Prostate Saturation Biopsy Form

Effective Date

09/27/2023

Last Reviewed

08/10/2023

Original Document

  Reference



This document addresses prostate saturation biopsy, also called prostate saturation needle biopsy, which involves taking numerous samples of prostate tissue in order to increase the likelihood of detecting prostate cancer in a subgroup of high-risk individuals in whom previous conventional prostate biopsies have been negative.

Note: Please see the following related documents for additional information:

  • CG-MED-45 Transrectal Ultrasonography
  • CG-SURG-98 Prostate Biopsy using MRI Fusion Techniques
  • GENE.00009 Gene Expression Profiling and Genomic Biomarker Tests for Prostate Cancer

Position Statement

Investigational and Not Medically Necessary:

Transrectal ultrasound-guided prostate saturation biopsy is considered investigational and not medically necessary.

Transperineal stereotactic template-guided prostate saturation biopsy is considered investigational and not medically necessary.