Yes, Medicare does cover Positron Emission Tomography (PET) scans.
What Medicare Part Covers PET Scans?
Medicare Part B (Medical Insurance) covers diagnostic non-laboratory tests, including PET scans. This coverage is provided when your doctor or another healthcare provider orders the scan as part of treating a specific medical problem.
When Is a PET Scan Covered by Medicare?
For a PET scan to be covered, it must be deemed medically necessary. This means:
- Doctor's Order: A licensed doctor or other healthcare provider must order the PET scan.
- Medical Necessity: The scan must be ordered as part of your treatment plan for an existing medical problem, such as diagnosing a condition, monitoring treatment effectiveness, or staging a disease.
For instance, PET scans are often used to:
- Diagnose various types of cancer.
- Determine the stage of cancer.
- Assess whether cancer treatment is working.
- Evaluate heart disease.
- Investigate certain brain disorders, like Alzheimer's disease or epilepsy.
Understanding Your Costs for a PET Scan
While Medicare Part B covers medically necessary PET scans, you will typically be responsible for certain costs:
- Part B Deductible: You must first pay your Medicare Part B deductible for the year.
- Coinsurance: After your deductible is met, you usually pay 20% of the Medicare-approved amount for the PET scan.
- Provider Acceptance: The facility and healthcare provider performing the PET scan must accept Medicare assignment.
These costs are standard for most services covered under Medicare Part B.
Quick Facts About Medicare PET Scan Coverage
Here's a quick overview of what to expect regarding Medicare coverage for PET scans:
| Aspect | Details |
|---|---|
| Medicare Part | Part B (Medical Insurance) |
| Requirement | Must be ordered by a doctor or healthcare provider as part of treating a medical problem. |
| Your Cost | You pay 20% of the Medicare-approved amount after meeting your Part B deductible. |
| Covered Situations | Diagnosis, staging, or monitoring of conditions like cancer, heart disease, and certain neurological disorders, provided they are medically necessary for your treatment. |
| Where Performed | Typically in a doctor's office, outpatient clinic, or hospital outpatient department. |
| Official Source | For more detailed information on Medicare coverage, visit the official Medicare website: www.medicare.gov/coverage |
Always consult with your doctor and the PET scan facility to understand your specific coverage and potential out-of-pocket costs before undergoing the procedure.
