Medicare and PET scans: coverage and costs

It may sound like a sci-fi movie weapon, but a Positron Emission Tomography (PET) scan is actually a good thing. It's a special kind of imaging process used to help doctors look at metabolic processes in the body. A PET scan creates a detailed image of how your tissues and organs are working-or not working. This can help doctors diagnose and monitor a number of medical conditions, including cancer, heart disease and neurological disorders.

The scan itself is a pretty simple process. First, you're given an injection containing a small amount of a radioactive substance. As the substance moves through your bloodstream, it's absorbed by tissues in your body, especially those that are more active-like cancer cells or brain cells. The PET scan then collects images of these areas to help doctors find and identify things like tumors or areas of unusual swelling or inflammation.

If a PET scan is deemed medically necessary, it will usually be covered by Parte B de Medicare. But there are a few rules:

• Your care provider must determine that the scan is medically necessary.
• You must visit a Medicare-approved inpatient or outpatient imaging facility.
• Depending on your plan, you may need a referral from your primary care provider to see a specialist.
• Prior authorization from Medicare may be required.
• If you’ve opted for a private Medicare Advantage Part C plan, you may need prior authorization from your plan provider.

Even with Part B coverage, you may have some out-of-pocket costs like deductibles, copayments or coinsurance. 

PET scans are generally covered by Medicare Part B. Your share of the cost will depend on whether you’ve satisfied your deductible—the amount you pay each year—before your insurance kicks in. In 2025, the Deducible de la Parte B is $257.

Once you've met your deductible for the year, you'll pay 20% of the cost of your scan. Medicare will pay the rest.

Por ejemplo:

• According to Medicare.gov, the national average cost for a PET scan in an outpatient facility is $920. Your 20% share would be $183.
• If you have your scan as an outpatient in a hospital, the average cost is $1,599, and your share would be $319.¹
• Without insurance, costs can range from $1,300 to more than $4,600.¹

If your doctor believes a PET scan is necessary but you're worried about the cost, you have options. Look for lower cost options by getting prices from more than 1 facility. An inpatient hospital PET scan may cost more than a scan from a freestanding imaging center. Freestanding centers specialize in medical imaging and aren't tied to specific doctors or hospitals.

If you have a Medicare Advantage plan, you will likely save money if you get your PET scan from a provider in your plan’s network.

For decades, X-rays were the only way for a doctor to "see" what was happening inside a patient. As imaging technology has improved, it has gotten more expensive, but an ounce of prevention is worth a pound of cure. A PET scan can help your doctor find problems sooner. And that may help save lives as well as money.