Medicare covers PET scans, but your out-of-pocket cost depends on which part of Medicare you have and whether your doctor orders it for a covered reason

A PET scan (positron emission tomography) is an imaging test that shows how your body's cells are working. Medicare Part B covers PET scans when a doctor orders one to diagnose or monitor certain cancers, heart conditions, or neurological diseases like dementia. The national average cost for a PET scan ranges widely — from around $3,000 to $6,000 for the scan itself — but what you actually pay depends on your coverage type and whether you've met your deductible.

If you have Original Medicare (Part A and Part B), you typically pay 20 percent of the approved amount after you've met your Part B deductible ($240 in 2024, though this changes yearly). If you have a Medicare Advantage plan, your cost-sharing varies by plan — some charge a copay (often $200 to $500), while others use coinsurance. The facility where you have the scan also affects the price: hospital outpatient departments usually cost more than independent imaging centers.

Key Takeaways

  • Original Medicare covers PET scans for specific cancers, heart conditions, and neurological diseases, and you pay 20 percent of the approved amount after your deductible.
  • Medicare Advantage plans cover PET scans but charge different amounts — check your plan documents or call your plan to find out your exact copay or coinsurance.
  • The facility location matters: hospital outpatient departments typically charge more than independent imaging centers for the same scan.
  • Your doctor must order the scan for a covered reason, and some scans require prior authorization from your plan before the test.
  • You can call the imaging facility ahead of time to ask what Medicare will pay and what your share will be based on your specific coverage.

What Original Medicare Pays for a PET Scan

Under Original Medicare Part B, the program pays 80 percent of the approved amount for a PET scan once you've paid your annual Part B deductible. The approved amount is set by Medicare and varies by location and facility type. In 2024, the Part B deductible is $240 per year. After you meet that deductible, you pay the remaining 20 percent of the approved amount.

For example, if Medicare approves $4,000 for your PET scan and you've already met your deductible, you would pay $800 (20 percent) and Medicare would pay $3,200. If you haven't met your deductible yet, you'd pay the full $240 deductible first, then 20 percent of the remaining approved amount. The actual approved amount your facility receives depends on whether it's a hospital outpatient department or an independent center — hospitals typically bill higher amounts.

Original Medicare does not cover PET scans ordered for routine screening or for conditions outside its coverage rules. Your doctor must document that the scan is medically necessary for diagnosis or monitoring of a covered condition. If your doctor orders a scan that Medicare doesn't cover, you could be responsible for the entire bill.

Medicare Advantage Plan Costs

If you have a Medicare Advantage plan (Part C), your cost for a PET scan depends entirely on your specific plan. Some plans charge a flat copay — commonly $200 to $500 — while others use coinsurance, meaning you pay a percentage of the cost. A few plans may cover PET scans with no out-of-pocket cost, though this is less common.

Your plan documents (the Summary of Benefits and Coverage or the Evidence of Coverage) list what you pay for imaging services. If you don't have your documents handy, call the customer service number on your insurance card and ask specifically: "What is my cost-sharing for a PET scan at an outpatient facility?" Be ready to tell them the reason your doctor is ordering it, because some plans have different costs depending on whether it's for cancer, heart disease, or another condition.

Many Medicare Advantage plans also require prior authorization before you have a PET scan. This means your doctor's office must contact your plan and get approval before scheduling the test. If you skip this step, your plan may deny the claim or charge you more. Ask your doctor's office whether they need to get authorization from your plan before your appointment.

How to Find Out Your Exact Cost Before the Scan

The best way to know what you'll pay is to contact the imaging facility directly and give them your Medicare information. Call the facility's billing department and say: "I have a PET scan scheduled. Can you tell me what Medicare approves for this scan and what my out-of-pocket cost will be?" Have your insurance card ready.

The facility can tell you the approved amount and calculate your share based on whether you've met your deductible (for Original Medicare) or what your plan's copay or coinsurance is (for Medicare Advantage). They can also tell you whether your plan requires prior authorization and whether they've already received it.

If the facility can't give you a clear answer, contact your Medicare plan directly. For Original Medicare, call 1-800-MEDICARE. For Medicare Advantage, call the number on your insurance card. Ask them to confirm the approved amount and your cost-sharing responsibility. Getting this information before your scan prevents surprise bills later.

Conditions Medicare Covers With a PET Scan

Medicare covers PET scans for specific medical reasons. The most common are certain cancers (including lung, breast, colorectal, lymphoma, and melanoma), coronary artery disease, and neurological conditions like dementia and Parkinson's disease. Your doctor must document that the scan is necessary to diagnose or monitor one of these conditions.

Medicare does not cover PET scans for routine health screening, weight loss monitoring, or general wellness checks. If your doctor wants to order a scan for a reason outside Medicare's coverage rules, you'll need to pay out of pocket or ask your doctor whether a different, covered test might work instead.

Some scans fall into a gray area where Medicare may cover them only under certain circumstances — for example, a PET scan for dementia may be covered only if other tests haven't given a clear diagnosis. Your doctor's office should know whether your specific situation meets Medicare's rules, but you can also ask your plan or call 1-800-MEDICARE if you're unsure.

Hospital Outpatient vs. Independent Imaging Centers

The location where you have your PET scan affects what Medicare pays and what you pay. Hospital outpatient departments typically charge higher amounts than independent imaging centers for the same scan. This is because hospitals have higher overhead costs and different billing structures.

If your doctor has ordered a PET scan, ask whether it can be done at an independent imaging center instead of a hospital outpatient department. The scan itself is the same, but your out-of-pocket cost may be lower. Some independent centers also offer payment plans if you need to spread your cost over several months.

Not all imaging centers offer PET scans — this is a specialized test — so your options may be limited by what's available in your area. Your doctor's office can tell you which facilities near you perform PET scans and whether they accept your Medicare coverage.

What Happens if You Receive a Surprise Bill

If you receive a bill for more than you expected, first check whether the facility billed Medicare correctly. Call the facility's billing department and ask them to explain the charges. Sometimes errors happen — a facility may have billed the wrong code or failed to submit the claim to Medicare.

If the bill is correct but higher than you were told it would be, you have the right to dispute it. For Original Medicare, contact your Medicare Administrative Contractor (MAC) — you can find yours at dmh.cms.gov. For Medicare Advantage, contact your plan's appeals department using the number on your insurance card.

You can also file a complaint with your state's insurance commissioner if you believe you were treated unfairly. Keep copies of all bills, explanations of benefits, and any conversations you had about cost before your scan.

Frequently Asked Questions

Do I need prior authorization for a PET scan under Medicare?

Original Medicare does not require prior authorization, but your doctor's office should verify that your scan meets Medicare's coverage rules. Many Medicare Advantage plans do require prior authorization, so check with your plan before scheduling. Ask your doctor's office to handle this step — they usually contact your plan directly.

Will Medicare cover a PET scan if my doctor thinks I might have cancer but it's not confirmed?

Yes. Medicare covers PET scans to help diagnose cancer, not just to monitor cancer you already have. Your doctor must document that the scan is medically necessary based on your symptoms or test results. If your doctor believes a PET scan will help determine whether you have cancer, that generally meets Medicare's coverage rules.

What if I haven't met my Part B deductible yet?

You'll pay your remaining deductible first, then 20 percent of the approved amount. For example, if you've paid $100 of your $240 deductible and your scan costs $4,000, you'd pay $140 to finish the deductible, then $780 (20 percent of $3,900), for a total of $920.

Can I choose a cheaper imaging center to lower my cost?

Yes, if one is available in your area. Ask your doctor whether your scan can be done at an independent imaging center instead of a hospital. Independent centers often charge less, and Medicare's 20 percent coinsurance will be lower as a result. However, not all areas have independent PET scan centers, so your options may be limited.

What if the imaging facility is out of network for my Medicare Advantage plan?

Most Medicare Advantage plans cover PET scans at any facility that accepts Medicare, whether in-network or out-of-network. However, you may pay more if you go out-of-network. Call your plan before scheduling to confirm whether the facility is in-network and what your cost will be if it isn't.