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FDG PET Reimbursement
In general the payment for the supply of the radiopharmaceutical FDG is included in the payment for the procedure. Restaging only occurs after a course of treatment is completed, and this is covered, subject to the conditions above. PET is not covered for other diagnostic uses, and is not covered for screening testing of patients without specific signs and symptoms of disease.
Payment Reform for Calendar Year medicare reimbursement breast cancer pet Medicare has addressed the issue of frequency limitations with the following general statement: Therefore, the use of PET in the diagnosis of lymphoma, esophageal, and colorectal cancers as well as in melanoma should be rare. Providers should consult with their local Medicare contractor to determine if other frequency limitations have been established. The coverage for breast and thyroid cancer is more narrowly focused than for the other covered malignancies.