What Medicare Covers for PET Scans and What You Pay

Medicare covers PET scans, but only for specific conditions and only when your doctor orders them as medically necessary

Medicare Part B covers positron emission tomography (PET) scans for certain cancers, neurological conditions, and cardiac issues. The scan itself is covered at 80 percent after you meet your Part B deductible — you pay the remaining 20 percent. However, Medicare will not pay for a PET scan ordered for screening purposes, for conditions outside its approved list, or without proper documentation from your doctor that the scan is medically necessary for diagnosis or treatment planning.

The conditions Medicare covers PET scans for have changed over time and continue to expand. Your doctor's office should know whether Medicare will cover the specific scan they are ordering, but you can also check with your imaging center or call Medicare directly at 1-800-MEDICARE before the procedure to confirm coverage for your situation.

Key Takeaways

Medicare Part B covers PET scans for certain cancers (including lung, breast, colorectal, and lymphoma), dementia evaluation, and some cardiac conditions, but your doctor must document that the scan is medically necessary.
You pay 20 percent of the Medicare-approved amount for the scan after meeting your Part B deductible, which is $240 in 2024 (the deductible amount changes yearly).
Medicare does not cover PET scans ordered for routine screening or for conditions not on its approved list, even if your doctor recommends one.
Your imaging center or doctor's office can tell you before the scan whether Medicare will cover it, and you should confirm this to avoid unexpected bills.
If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower than the standard 20 percent, depending on your plan's coverage.

Which Conditions Medicare Covers PET Scans For

Medicare covers PET scans for a defined list of conditions. The most common are certain cancers: lung cancer, breast cancer, colorectal cancer, lymphoma, and melanoma. For these cancers, Medicare covers PET scans for initial staging (determining how far the cancer has spread), restaging (checking whether cancer has returned or spread after treatment), and monitoring treatment response.

Medicare also covers PET scans for dementia evaluation when a doctor is trying to distinguish between Alzheimer's disease and other forms of dementia. For cardiac patients, Medicare covers PET scans to assess myocardial viability — essentially, to determine whether heart tissue can be salvaged before bypass surgery or other intervention.

The list of covered conditions is not exhaustive and has grown in recent years. If your doctor is ordering a PET scan for a condition not listed here, ask them whether they believe Medicare will cover it based on current policy. Your imaging center can also look up the specific coverage rules for your diagnosis code.

What You Pay Out of Pocket

Your cost for a PET scan depends on whether you have met your Part B deductible for the year. In 2024, the Part B deductible is $240. Once you have paid that amount toward Part B services in a calendar year, Medicare covers 80 percent of the approved amount for the PET scan, and you pay 20 percent.

The actual dollar amount you pay depends on the imaging center's charge and what Medicare approves for that service in your geographic area. A PET scan typically costs between $3,000 and $6,000 before insurance, but Medicare's approved amount is usually lower. If you have already met your deductible earlier in the year, your 20 percent cost might be $400 to $800. If you have not met your deductible, you pay the full deductible first, then 20 percent of the approved amount.

If your imaging center is out-of-network or does not accept Medicare assignment, you may owe more. Always ask whether the facility accepts Medicare assignment before scheduling.

How to Confirm Coverage Before Your Scan

Do not assume Medicare will cover your PET scan just because your doctor ordered it. Call the imaging center where you are scheduled and ask them to verify coverage with Medicare before your appointment. Provide them with your Medicare number, your diagnosis code (the medical reason for the scan), and the specific type of PET scan being ordered.

The imaging center's billing department can contact Medicare's local contractor to confirm whether the scan is covered. This usually takes one to three business days. Ask them to send you a written confirmation of what Medicare will cover and what you will owe.

You can also call Medicare directly at 1-800-MEDICARE and ask whether a PET scan is covered for your specific condition. Have your diagnosis code ready. Medicare's phone lines are open Monday through Friday, 8 a.m. to 8 p.m. Eastern time.

What Happens If Medicare Denies Coverage

If Medicare denies coverage for your PET scan, you have the right to appeal. Your doctor or imaging center can file an appeal on your behalf, or you can do it yourself. The appeal process has multiple levels, and many denials are overturned at the first level of appeal.

If you proceed with the scan without confirming coverage and Medicare later denies it, you could be responsible for the full bill — unless you signed an Advance Beneficiary Notice (ABN) before the scan. An ABN is a form that tells you Medicare may not cover the service and that you agree to pay out of pocket if it does not. If you did not sign an ABN and Medicare denies coverage, the imaging center generally cannot bill you for the denied service.

Ask your imaging center whether they will file an appeal if Medicare denies coverage. Some centers do this routinely; others require you to request it.

Medicare Advantage and Medigap Coverage for PET Scans

If you have a Medicare Advantage plan (Part C), your coverage for PET scans is determined by your specific plan, not by Original Medicare rules. Some Advantage plans cover the same conditions Medicare does; others have different rules or higher out-of-pocket costs. Check your plan's coverage documents or call your plan's customer service line to confirm whether your PET scan is covered and what you will owe.

If you have a Medigap (supplemental insurance) plan, it typically covers the 20 percent coinsurance that Original Medicare does not pay, as long as Medicare covers the scan. This means you would owe only your Part B deductible, not the additional 20 percent. However, Medigap plans do not change what Medicare covers — if Medicare denies the scan, Medigap will not pay for it either.

Frequently Asked Questions

Can I get a PET scan for cancer screening if I do not have symptoms?

No. Medicare does not cover PET scans for screening purposes, even for people at high risk of cancer. Medicare covers PET scans only when there is a diagnosis or strong clinical suspicion of cancer and the scan is needed to stage, restage, or monitor treatment. If your doctor recommends a screening PET scan, you would pay the full cost out of pocket.

What if my doctor says the PET scan is medically necessary but Medicare says it is not covered?

Your doctor can appeal Medicare's decision and provide clinical evidence that the scan is necessary for your care. Many appeals succeed, especially when the doctor documents why the scan is essential for treatment planning. Ask your doctor's office to file an appeal and to provide Medicare with detailed clinical notes supporting the need for the scan.

Will I owe anything if I have already met my Part B deductible?

Yes, you will still owe 20 percent of Medicare's approved amount for the PET scan. Meeting your deductible only means you do not pay the deductible again that year — you still pay coinsurance (the 20 percent) for most services. If you have Medigap coverage, your plan may cover that 20 percent.

Can I choose any imaging center for my PET scan?

You can choose any imaging center that accepts Medicare, but costs may vary. Ask whether the center accepts Medicare assignment, which means they agree to accept Medicare's approved amount as full payment (except for your deductible and coinsurance). Centers that do not accept assignment can bill you for the difference between their charge and Medicare's approved amount.

How long does it take to get results from a PET scan?

A radiologist typically interprets the scan within one to three business days. Your doctor's office will contact you with results. This timing does not affect Medicare coverage — coverage depends on whether the scan was medically necessary, not on how quickly you receive results.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.