Do insurance companies pay for PET scans? Even with insurance, PET scans can be expensive. The typical patient with health insurance will pay between 10% and 50% of the procedure. If your doctor suggests a PET scan, check with your insurance company.
Why would insurance not approve a PET scan? Avoid insurance claim denials on cancer PET scans
And because coders are not allowed to use a diagnosis other than the diagnosis listed on the order, at times these PET scans are denied by payors when they could have been paid as meeting Medical Necessity based on the patient’s complete clinical picture.
What diagnosis will cover a PET scan? Some of the reasons your doctor might order a PET scan include: characterization of pulmonary nodules. diagnosis and staging of small cell lung cancer. diagnosis and staging of esophageal cancer.
How many PET scans Does Medicare pay for? If ordered by a doctor, Medicare Part B will typically cover 80% of the cost of a PET scan, up to three times per year. You’ll be responsible for the remaining 20% after you meet your annual deductible for Medicare Part B, which is $233 per year in 2022.