Medicare PET/CT Reimbursement for Oncology: What’s covered, what’s notPosted on: 08.16.18
PET/CT is a vital diagnostic imaging tool and is especially effective in revealing conditions such as cancer and brain disorders. When it comes to Medicare coverage, there are a number of misconceptions about PET/CT reimbursements.
In the majority of cases, PET/CT imaging is covered when clinically necessary, either as an initial treatment strategy or a subsequent treatment strategy.
Few exceptions apply to specific breast and cervical cancer, and melanoma diagnoses. The initial treatment of prostate cancer is the only non-covered event. Below is a consolidated reference chart that details PET/CT insurance reimbursement for specific conditions.
|Tumor Type||Initial Treatment Strategy||Subsequent Treatment Strategy|
|Breast Cancer (female & male)||*CWE||✓|
|Head & Neck Cancer (not thyroid or CNS)||✓||✓|
|Non-Small Cell Lung Cancer||✓||✓|
|Small Cell Lung Cancer||✓||✓|
|Soft Tissue Sarcoma||✓||✓|
|All other solid tumors||✓||✓|
|All other cancers not listed||✓||✓|