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Medicare PET/CT Reimbursement for Oncology: What’s covered, what’s not

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
Brain Cancer
Breast Cancer (female & male) *CWE
Cervical Cancer *CWE
Colorectal Cancer
Esophageal Cancer
Head & Neck Cancer (not thyroid or CNS)
Lymphoma
Melanoma *CWE
Myeloma
Non-Small Cell Lung Cancer
Pancreatic Cancer
Prostate Cancer Non-covered
Ovarian Cancer
Small Cell Lung Cancer
Soft Tissue Sarcoma
Testicular Cancer
Thyroid Cancer
All other solid tumors
All other cancers not listed
Making Healthcare Convenient. As Needed. When Needed. Where Needed.

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