Test Utilization

What’s Changing?

Beginning March 9, 2026, a new Order Validation Rules in Epic will apply to all PSA Screening orders. These rules act as hard stops and must be corrected before the order can be signed.

Applies to:

• Prostate Specific Antigen (PSA), Screening [LAB116]

Epic will stop the order if:

Diagnosis Code Is Not Z12.5. Z12.5 (Screening for Prostate Cancer) is required for all PSA Screening orders.

Patient Is <40 Years Old With BCBS Coverage. BCBS does not cover PSA Screening for this group.

Patient Is <50 Years Old With Medicare / Medicare Advantage. Medicare does not deem PSA Screening medically necessary before age 50.

Screening Was Performed Within the Past 11 Months. Annual screening limits apply; users must change the expected date if needed.

Important for Providers Ordering Outside Epic

External practices will not see Epic’s validation warnings, but the draw site (phlebotomy team) will.

What Happens at the Draw Site?

If a paper/EMR PSA Screening order violates any rule:

1. Phlebotomy attempts to enter the order.
2. A hard stop fires in Epic.
3. The phlebotomist cannot override the alert.
4. The order cannot be placed, even with a signed requisition.
5. Staff will:

Inform the patient
Contact the ordering provider for correction
Hold the draw until the provider updates the order

This may require the patient to return if changes can’t be made immediately.

How Providers Can Prevent Delays

✔ Use Z12.5 for all PSA Screening orders
✔ Confirm age + insurance coverage requirements
✔ Ensure no PSA Screening has occurred in the past 11 months
✔ Order a diagnostic PSA instead of a screening when appropriate (symptoms, abnormal findings, ongoing monitoring)