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Medicare not covering two year surveillance PET scan
I’ll be having my second annual PET scan done in two days. I just received an electronic message from the hospital that Medicare will not cover this PET scan.
My first annual PET scan last year was covered by Medicare. My understanding is that many of us have these annual surveillance procedures pretty much up to five years. Has anyone else recently been denied Medicare coverage for their second surveillance PET scan?
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Good Lord! I've had two in the last three months. I finished treatment at MD Anderson last May 15. The esophageal cancer is gone, but I turned up a small (1/2") spot in my upper left lung lobe. Since it's in a spot difficult to biopsy, they propose to treat it as malignant. I'm sure that'll be followed by one or more PETs. With this cancer's reputation for recurrence and late metastasis, cutting off PETs at one year after NED seems unduly harsh. I hope you appeal...
I had a PET scan after my last treatment covered by Medicare but they would only cover CT scans every 6 mos. after that.
I'm in New Zealand. We get 1 PET scan when initially diagnosed then nothing.
Also we do not get regular gastroscopies, CT or anything else. Just regular blood tests that's it
Do you have Original Medicare or an Medicare Advantage plan?
OK - good news! When I checked-in for my 2nd annual PET 3days ago, I told the person checking me in about about how freaked out I was about Medicare not covering my PET, she looked up my electronic file and said I AM COVERED and that someone had originally PUT IN THE WRONG CODE. And here I was ready to have to pay $7,000 and was going to ask for a payment plan!
Not to self: start with doctors office about what claim was submitted.
Mahalo nui loa (Thank You Very Much) to everyone for your responses and support🌺
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2 ReactionsI have a Medicare Advantage plan. Mediare denied the first PET; my oncologist appealed the decision and Medicare approved it. This happened again on the second one but the last 2 have been denied even after the oncologist appeal. Now, I am limited to CT scans.
@ja2 I assume the last two showed clear?
Yes, clear for cancer. The first of the last 2 CT scans showed fluid in the left lung and a small nodule in the right lung. The oncologists chose not to drain the fluid at the time.
The last PET scan also showed the small nodule in the right lung. However, the last CT scan made no reference to fluid in the left lung or the small nodule in the right lung. I felt some reference should have been made as to why neither was addressed in the 2nd CT. There were Another CT scheduled in September.
I had a reason for asking. I finished treatment on 5/15 last year and PETs done in October, December and then a couple of weeks ago showed no cancer in the esophagus and nodes. Same result with a EUS/CT and biopsy in October. However, a small nodule showed up in my left upper lung lobe in October. It had mild activity, decreasing to SUV 2.3 in December, normal being 0-2.5. So, I forgot about it until a couple of weeks ago. It had grown from .8cm to 1.4cm and its activity jumped up from 2.3 to 7.4. Because of age, then don't want to remove that lobe. They want to spot treat it with TrueBeam - four sessions over a week, with high intensity. Given the circumstances, I certainly want it followed afterwards and your difficulty with Medicare caught my eye...
On Tuesday, April 14, 2026 at 04:35:43 PM CDT, Mayo Clinic Connect < nf+113879cd+112517606@n1.hubapplication.com> wrote:
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| Reply by @ja2 to a comment you posted on discussion "Medicare not covering two year surveillance PET scan"
Excerpt of your comment
@ja2 I assume the last two showed clear?
Their reply
Yes, clear for cancer. The first of the last 2 CT scans showed fluid in the left lung and a small nodule in the right lung. The oncologists chose not to drain the fluid at the time.
The last PET scan also showed the small nodule in the right lung. However, the last CT scan made no reference to fluid in the left lung or the small nodule in the right lung. I felt some reference should have been made as to why neither was addressed in the 2nd CT. There were Another CT scheduled in September.
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