Among the most advanced scans available in medical diagnostics today, the positron emission tomography scan, or PET scan, is one of the most accurate in detecting diseases like cancer and problems within the central nervous system. These days, combination PET scan are often completed using advanced scanning stations that add in magnetic resonance imaging or computerized axial tomography for a full picture of organ health and processing, especially in terms of blood sugars.
Does Medicare Cover PET Scans?
If you require a PET scan and are a Medicare recipient, the procedure will likely be covered under Medicare Part B. This is the part of Medicare that offers benefits for medically necessary service and supplies and outpatient treatment in a clinical setting. Since PET and similar scans are carried out as diagnostic measures, they will fall into this category. In most cases, a PET scan is considered to be a diagnostic non-laboratory test, and like other imaging covered by Medicare, the cost to the patient will be 20% after the plan’s deductible has been met. Additionally, the PET scan will need to be ordered by your physician or specialist at a qualifying outpatient clinic in order to qualify under Medicare Part B, and the test will have to be deemed as medically necessary.
The only exception to this designation is if the PET scan is completed during a temporary stay in a skilled nursing facility or when you are formally admitted into a hospital, as this would fall under Medicare Part A.
Understanding the PET Scan Procedure
If your doctor believes there is a possibility that your symptoms may be due to a disease that is not able to be diagnosed through lab work or an office visit, he or she may order a PET scan. Your appointment may be scheduled at the time of your doctor’s visit, but you may also have to make your own appointment if the scan will be completed at a separate location.
You may be instructed to consume certain foods, like those high in protein, prior to the test, but you will likely be required to fast at least six hours prior to your appointment. Let your doctor know about any medications or supplements you are taking. On the day of your scan, try to arrive early enough to register and fill out paperwork.
The test is painless, but it does require you to lay on a table that will then pass through a small tunnel. You will be completely safe during the test, but some patients who experience claustrophobia may feel nervous. This is totally normal, and throughout the test, the technician directing the machine will stay in contact with you to make sure you’re feeling comfortable.
The scan itself will likely take around 30 minutes, but prior to beginning the test, you will need to have an IV inserted. This is to allow for special dye to be injected that will show up on the test results. When accounting for the time it takes to have the IV inserted, the time it takes for the dye to work through your body and the time it takes for the scan itself, you may be looking at approximately two hours of time spent at the diagnostic facility, not counting the time for registration.
Can You Get a PET Scan on Your Own?
As mentioned previously, in order for Medicare Part A or Part B to provide coverage for a PET scan, the test must be ordered by your doctor and must take place at a facility approved by Medicare. This means that if you were to seek out your own PET scan, you would not be covered. In fact, you likely would not even be able to pay for a PET scan on your own because a facility would not conduct one without a doctor’s order to do so. For these reasons, you should follow your physician’s recommendations regarding all diagnostic testing so that he or she can work with you to diagnose and treat any ailment you may be facing.
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