Most insurance companies pay for clinically indicated PET/CT scan procedures. To be clinically indicated or medically necessary, the procedure must be potentially beneficial in providing information supportive of a diagnosis or monitoring disease progression or treatment success. It is always advisable to check coverage details with the insurance provider prior to your appointment for the PET/CT scan.
We recognize and accept:
- Private Insurance
- National Oncologic PET Registry (NOPR)
Private payers can have wide variations in coverage policies, coverage criteria or procedures. Your referring physician is responsible for obtaining prior-authorization and providing proof of medical necessity for the scan.
The cost of the scan has three components: the radiopharmaceutical, the PET/CT scan procedure and the professional fee for the radiologist who interprets the scan.
Patients are responsible for deductibles, co-payments and remaining balances. All patients should bring their insurance cards to the imaging center on the day of their appointment.
If private insurance does not cover the PET/CT scan, then the patient may choose to self-pay. Please call our billing department (916) 737-3211 to discuss payment arrangements.
View a list of Medical Groups and Contracted Health Plans for Northern California PET Imaging Center.
The Centers for Medicare and Medicaid Services (CMS) decides coverage for PET/CT scans through a National Coverage Determination (NCD) section 220.6. The coverage policy is the same nationwide.
In April 2009, CMS announced an expanded coverage policy for oncology PET/CT scans to cover PET/CT scans in the initial treatment strategy of patients with cancer. This decision was based, in large part, on compelling clinical evidence of the effectiveness of PET/CT for cancer management and treatment contained in a comprehensive study known as the National Oncologic PET Registry (NOPR).
View a table of the Expanded PET/CT Coverage, effective April 6, 2009.
Medi-Cal will pay for PET/CT scans based on medical necessity as determined by the primary care physician. Northern California PET Imaging Center cannot accept Medicaid from other states.
National Oncologic PET Registry (NOPR)
The National Oncologic PET Registry (NOPR) was developed in response to CMS proposal to expand coverage for PET/CT scans to include cancers and indications not presently eligible for Medicare reimbursement. Coverage is available if the referring physician and the imaging center are willing to submit data to the clinical registry to assess how the PET/CT scan impacted the management and care of the cancer patient.
Northern California PET Imaging Center works with your physician to submit the data required for you to participate in the NOPR and obtain Medicare coverage for otherwise non-covered imaging services.
Call us if you need more information about insurance coverage (916) 737-3211.