PET scans help doctors detect cancer, heart disease, and brain disorders by showing how tissues function. Many Medicare beneficiaries need this imaging for diagnosis or monitoring. Costs concern most people facing the test.
Medicare covers PET scans when medically necessary under specific conditions. Coverage falls primarily under Part B for outpatient procedures. Inpatient scans use Part A.
In 2026, national averages from Medicare show outpatient PET scan costs around $920 in facilities or higher in hospital settings. Your share depends on deductibles and coinsurance. This guide explains coverage, expenses, and ways to manage them.
Medicare Coverage for PET Scans
Medicare Part B covers PET scans as diagnostic non-laboratory tests when ordered by a doctor. Approval requires medical necessity, often for cancer staging, cardiac issues, or neurological conditions. Scans use radiotracers like FDG to highlight abnormal activity.
Coverage limits apply to certain codes and indications. Medicare approves most common PET procedures for oncology and cardiology. Always confirm eligibility with your provider beforehand.
Part A covers PET scans during inpatient hospital stays. This happens rarely for diagnostic purposes alone. Most occur outpatient under Part B.
2026 Costs Under Original Medicare
The Part B annual deductible is $283 in 2026. Once met, Medicare pays 80% of the approved amount. You pay 20% coinsurance on the rest.
National averages place outpatient PET scans at about $920 in ambulatory settings. Your 20% share equals roughly $184 after the deductible. Hospital outpatient departments average $1,599, with your share around $320.
These figures represent Medicare-approved amounts, not retail prices. Providers accepting assignment limit charges to approved levels. Location and scan type influence exact costs.
Key 2026 Cost Factors:
- Part B deductible: $283 annually.
- Coinsurance: 20% after deductible.
- Monthly Part B premium: $202.90 standard for most.
- No annual out-of-pocket maximum in Original Medicare.
These elements determine your final responsibility.
Comparison of PET Scan Costs by Setting
Here’s a comparison of average costs for common outpatient PET scans in 2026:
| Setting | Medicare-Approved Average Cost | Your 20% Coinsurance (After Deductible) |
|---|---|---|
| Ambulatory/Outpatient Facility | $920 | ~$184 |
| Hospital Outpatient Department | $1,599 | ~$320 |
| Inpatient (Part A) | Bundled in hospital stay | Subject to Part A deductible/coinsurance |
This table uses national averages from Medicare data. Actual amounts vary by region and procedure code.
Factors Affecting Your PET Scan Cost
Scan type influences pricing, with full-body or brain-specific scans differing. Facility choice matters, as hospital outpatient settings cost more than independent centers. Provider assignment acceptance prevents balance billing.
If you have not met the Part B deductible, you pay the full approved amount up to $283 first. Higher-income beneficiaries face income-related premium adjustments increasing monthly costs. Radiotracer fees bundle into the procedure payment.
Multiple scans in a year may repeat deductible and coinsurance. Medicare limits frequency based on medical need. Discuss with your doctor to plan appropriately.
Medicare Advantage and PET Scan Costs
Medicare Advantage plans cover PET scans at least as well as Original Medicare. Many set copays instead of coinsurance for imaging. Out-of-pocket maximums cap yearly expenses, often lower than Original Medicare totals.
Plans vary in networks, requiring in-network facilities for lowest costs. Some include extras like transportation to scans. Premiums differ, with some at $0 beyond Part B.
Compare during open enrollment for better cost control. Use Medicare Plan Finder to review local options. Advantage suits those wanting predictable expenses.
Ways to Reduce Your Out-of-Pocket Costs
Choose assignment-accepting providers to avoid extra charges. Meet your deductible early in the year if possible through other services. Explore financial assistance programs for low-income beneficiaries.
Medigap policies cover the 20% coinsurance and deductible for Original Medicare users. These supplements add monthly premiums but reduce PET scan burdens. State programs may offer help for premiums or costs.
Cost-Saving Tips:
- Ask your doctor about lower-cost facilities.
- Confirm medical necessity to ensure coverage.
- Use Medicare.gov tools for price lookups.
- Consider Advantage plans with low copays.
- Apply for Extra Help if eligible for drugs.
These steps ease financial impact.
What PET Scans Typically Detect
PET scans excel at showing metabolic changes in tissues. Cancer detection and staging represent common uses, highlighting tumor activity. Heart disease assessment checks blood flow and viability.
Brain disorders like Alzheimer’s or epilepsy benefit from functional imaging. Scans guide treatment decisions by revealing disease extent. Results combine with other tests for accurate diagnosis.
Preparation involves fasting and avoiding certain activities. The procedure takes about two hours total. Mild radiation exposure occurs from the tracer.
Potential Side Effects and Preparation
The radiotracer injection may cause minor discomfort at the site. Allergic reactions remain rare. Drink plenty of water afterward to flush the substance.
No major side effects occur for most people. Avoid close contact with infants or pregnant individuals briefly after the scan. Follow doctor instructions for diet and medications.
Preparation Tips:
- Fast for several hours before the scan.
- Inform staff of allergies or diabetes.
- Wear comfortable clothing without metal.
- Arrange transportation if sedated.
Proper prep ensures accurate results.
Navigating Approval and Claims
Your doctor submits documentation for medical necessity. Medicare reviews claims for covered indications. Pre-authorization may apply in some Advantage plans.
After the scan, review your Medicare Summary Notice for accuracy. Appeal denials with supporting records if needed. Providers handle most billing directly.
Contact 1-800-MEDICARE for questions on coverage. Keep records of all communications. This protects against unexpected bills.
Conclusion
PET scan costs with Medicare in 2026 center on Part B coverage with a $283 deductible and 20% coinsurance after that. National averages show your share around $184 to $320 depending on setting. Medicare Advantage or Medigap options often lower expenses further. Discuss with providers and use official tools to estimate and plan ahead.
FAQ
Does Medicare cover PET scans?
Medicare Part B covers PET scans when medically necessary for conditions like cancer or heart disease. Part A covers them during inpatient stays. Coverage requires doctor order and approved indications.
What is the 2026 Part B deductible for PET scans?
The Part B deductible is $283 in 2026. You pay this amount first toward the scan cost. Medicare begins paying 80% once met for the year.
How much coinsurance do I pay for a PET scan?
You pay 20% of the Medicare-approved amount after the deductible. For a $920 average scan, this equals about $184. Hospital settings may raise your share to around $320.
What is the average Medicare-approved cost for a PET scan?
National averages show $920 in outpatient facilities and $1,599 in hospital outpatient departments in 2026. These figures include the procedure and tracer. Actual amounts vary by location.
Do Medicare Advantage plans cover PET scans differently?
Advantage plans cover PET scans at least as well as Original Medicare. Many use copays instead of coinsurance. Out-of-pocket maximums cap total yearly costs.
Are there limits on how many PET scans Medicare covers?
Medicare covers PET scans based on medical necessity, often up to three per year for certain conditions. Frequency depends on diagnosis and doctor recommendation. Prior authorization may apply.
What if my provider does not accept Medicare assignment?
Non-assignment providers can charge up to 15% more than approved amounts. You pay the excess plus your 20%. Choose assignment-accepting facilities to limit costs.
Can Medigap help with PET scan costs?
Medigap policies cover the Part B deductible and 20% coinsurance for Original Medicare users. This reduces or eliminates your share of PET scan expenses. Premiums vary by plan type.
How do I find the exact cost in my area?
Use Medicare.gov Procedure Price Lookup tool with the PET scan code. Enter your ZIP code for local estimates. Contact providers for personalized quotes.
What should I do if I get a bill I can’t afford?
Discuss payment plans with the provider. Apply for financial assistance if eligible. Check Medicaid or state programs for extra help with Medicare costs.
Dr. Usman is a medical content reviewer with 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic health topics. His work is based on trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Usman is for educational purposes and does not replace professional medical advice.