Nationally, Medicare now allows up to three PET scans for subsequent treatment strategy. Coverage of any beyond that depends on the local contractor. How do we know if we can get paid for a fourth one or not?
In most cases, you will not know in advance, but keep a watch on your Medicare contractor’s website for any policy statements or articles concerning PET. Most likely this will be determined on a case-by-case basis based on the medical necessity as documented in your claim and any supporting material that you can provide.
We do recommend that you have the patient sign an advanced beneficiary notice (ABN) prior to a fourth exam.