PSMA/PET and MEDICARE

I receive 2 to 3 a year, as directed by my cancer team, and Medicare and my supplemental insurer have always paid in full. This is my personal experience.

It doesn't seem appropriate to call it overkill if the patient's doctor believes it is necessary to provide good care to him. As I have said before, my husband has had PSMA PET scans every three months since before he began Pluvicto, during Pluvicto infusions, and has continued with them every three months since finishing Pluvicto in August 2024. An interim C-11 Choline PET has sometimes been added in between, to catch active cancer cells that don't express PSMA. Doctors differ in how often they want to monitor a patient's cancer, and patients differ in that they have cancers requiring monitoring more or less often. I suspect true overkill is pretty rare.

Ok thank you, as bad as this is that’s one small stream of less worry for me. I have the same coverage, original Medicare + G.

That is fantastic progress sounds like it’s being managed well, and he has gained a lot of time.

Did they talk about Pluvicto?

I know that some people have an incredible reduction in visible Metastasis with Pluvicto.

People who lit up the pet scam like a Christmas tree have had dramatic reductions in cancer.

@trchar
As long as you are on traditional (original) Medicare you can call them and they can answer your questions. As you can see many posters have said not a problem with being covered for them. But if me would call and check to confirm.

You mentioned how many in a year so Medicare could answer this. I find CVS Medicare quite helpful. Medicare Advantage is another story all together with many restrictions that Medicare original does not have. But I think you stated in a post you have Medicare original. That is good. For peace of mind just call them. I did when I was considering Proton radiation for my prostate cancer even though the providers said was covered.

I feel fairly confident that if the oncologist feels it’s medically necessary they will cover it, I honestly do not foresee a problem. Some posters here have original Medicare and have not run into a failure to pay the claim even having a PSMA/PET every three months. Although their situation may be unique and different from mine. Thank you for the suggestion though, I wanted to avoid being on hold for hours. Last time I called about a second CT-scan within two months they said “We don’t care how many you have as long as it’s medically necessary” we will cover it.

I think I had to sign somethjng like that for an eye exam at Bascom Palmer. The doctor looked and found my medical history online and e started dressing me down about “ wasting their time” when they sent me a bill I called the omsbudsman and they forgave the bill.
I just red in one of the blogs that what I’m experiencing is not an eye disorder but a brain disorder which is why he saw that I’ve been going to eye doctors for over ten years None of these specialist saw that I need a neurologist.
Just another Faux pas by know it all doctors.
I’m hoping to hear from the doctor who wrote the blog about this vison problem
Thanks for educating me about ABN

I know that when my doctor at UCLA orders a PSMA PET/CT scan (and I am having another one in ten days), they verify my coverage with Medicare (conventional) and what I have been told that as long as they follow the protocol, Medicare will pay. Medicare does not require pre-authorizations, unlike Medicare Advantage and private insurance plans do.

Hi, no they haven't I had to google it to see what it was. His at this stage has not spread to any other organs, just contained in the bones.
The oncologists did say however when it is no longer contained there a few other things they are able to do.
The radiation clinic last year said they can help if it gets close to the nerve in his back.
Thank you for this information though at next appointment I will mention it.