How Many PET Scans Will Medicare Pay For?
Medicare covers PET scans for certain medical conditions, but there are limits on the number of scans that Medicare will pay for. The number of PET scans that Medicare will pay for depends on the type of cancer and the stage of the cancer.
Medicare Coverage for PET Scans
Medicare covers PET scans for the following medical conditions:
- Cancer
- Heart disease
- Brain disorders
- Infections
Medicare will also cover PET scans for other medical conditions if the doctor can show that the scan is medically necessary.
Limits on Medicare Coverage for PET Scans
Medicare has limits on the number of PET scans that it will pay for each year. The number of scans that Medicare will pay for depends on the type of cancer and the stage of the cancer.
For example, Medicare will cover up to four PET scans per year for patients with lung cancer. For patients with breast cancer, Medicare will cover up to three PET scans per year.
Medicare will not cover PET scans that are not medically necessary. For example, Medicare will not cover PET scans that are used for screening purposes.
How to Get Medicare Coverage for a PET Scan
To get Medicare coverage for a PET scan, you must:
- Have a doctor's order for the scan.
- Go to a Medicare-approved PET scan facility.
- Pay the Medicare deductible and coinsurance.
If you have a Medicare Advantage plan, you must follow the plan's rules for getting coverage for a PET scan.
Appealing a Medicare Coverage Denial
If Medicare denies your claim for a PET scan, you can appeal the decision. You have 60 days to file an appeal. The appeal process can take several months.
If you are successful in your appeal, Medicare will pay for the PET scan.
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