Insurance Coverage

Most insurance companies pay for clinically indicated PET and PET/CT procedures. To be clinically indicated, the procedure must be potentially beneficial in providing information supportive of a diagnosis or monitoring certain conditions.

Private Insurance
Generally, most private insurance companies cover the same indications as Medicare, although some may cover more indications and some may cover fewer indications. Private payers can have wide variations in coverage policies, coverage criteria or procedures. The referring physician and the imaging center work together to verify specific local coverage guidelines and to obtain pre-authorization prior to performing the scan.

Medicare
The Centers for Medicare and Medicaid Services (CMS) coverage policies for PET and PET/CT indications are decided at a national level and are documented in a National Coverage Determination (NCD), section 220.6 Medicare Covered Indications.

National Oncologic PET Registry (NOPR)
The National Oncologic PET Registry (NOPR) was developed in response to the Centers for Medicare and Medicaid Services (CMS) proposal to expand coverage for FDG PET to include cancers and indications not presently eligible for Medicare reimbursement. Medicare reimbursement for these cancers is available if the patient's referring physician and the imaging provider submit data to a clinical registry to assess the impact of PET on cancer patient management. The NOPR implements this registry for CMS.

Please contact our office with questions regarding insurance and coverage for PET scans.


Regional Medical Center
400 East 10th Street
Anniston, AL 36202
P - 256.235.5277
F - 256.235.5900

Hours of Operation:
Monday - Friday
8 am - 3:30 pm

Our Staff:
Dr. David J. Bodne, MD
Dr. Robert Stone, MD
Sharon Turner, RT (R) ARRT
    Nuclear Medicine Supervisor
Vincent Glanze, RT (R)(CT) ARRT
    CT Supervisor
Darla Buse, RT (R)(CT) ARRT
    PET/CT Technologist
Kelly Ford, RT (R)(CT) ARRT
    PET/CT Technologist

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