Does Medicare Cover PET Scans?

Written by:

Kayla Missman

Reviewed by:

Jason Kolkey

6 min read

Key Takeaways

PET scans are a type of imaging test that can be used for early detection of cancer, heart disease, and brain disorders.
Original Medicare covers PET scans when medically necessary to diagnose or monitor a health condition.
Laboratory tests and other outpatient procedures are covered under Medicare Part B, which is medical insurance.
Medicare Advantage plans must at least match the coverage for laboratory tests you would receive from Original Medicare.

Does Medicare cover PET scans? The answer is yes, Medicare covers PET scans when a doctor orders them to diagnose or monitor a health condition. PET scans, along with other diagnostic tests like MRIs and CT scans, are included in Medicare Part B. This article details how PET scans work, when Medicare covers them, and how much they cost.

What Are PET Scans?

A positron emission tomography (PET) scan, is an imaging test that uses a radioactive drug, called a tracer, to identify metabolic activity in the body’s tissues and organs. Once the tracer is injected, it concentrates in areas of the body with higher levels of activity, which may indicate disease. PET scans can identify cancer, brain disorders, or heart disease earlier than other tests. They can also monitor the effectiveness of cancer treatment or catch signs that cancer has recurred after treatment.

PET scans identify diseases that disproportionately affect older adults who are insured through Medicare. For example, people over 75 have the highest prevalence of heart disease, according to the Centers for Disease Control and Prevention (CDC). Age is also a risk factor for cancer.

PET scans are crucial for early detection, helping doctors make the best treatment decisions as soon as possible. Medicare coverage allows beneficiaries to get PET scans without worrying about the full cost.

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How Medicare Covers PET Scans

Medicare Part B, the part of federally administered Original Medicare that provides medical insurance, covers preventative care and medically necessary outpatient procedures like PET scans. To be covered, the PET scan must be:

Ordered by a doctor
Used to diagnose or monitor a health condition
Performed at a facility that accepts Medicare

If you have already met your annual Part B deductible, Medicare will pay 80% of the cost of your PET scan. You’ll be responsible for the other 20%. If you get a PET scan in a hospital as an outpatient, you may also owe a hospital copayment.

How Medicare Advantage Covers PET Scans

Medicare Advantage plans, sold by private insurance carriers, substitute for Medicare Part A and Part B. They must provide at least as much coverage as Original Medicare, including for PET scans, and may feature additional benefits. Plans differ by insurance carrier and availability depends on the ZIP code where you live

Medicare Advantage plans come with some other considerations, though. With Original Medicare, you can get care from any doctor or hospital that accepts Medicare. Most Medicare Advantage plans use a preferred provider network, which limits where you can go.

Some plans allow you to get out-of-network care for a higher cost. Other plans won’t cover out-of-network care at all, except in emergency situations, so pay attention to your plan type. PET scans can be costly without insurance coverage.

If you have specific questions about your Medicare Advantage plan coverage, contact your insurance carrier directly for guidance.

How Much PET Scans Cost With Medicare

Like all healthcare procedures, the cost of a PET scan depends on its complexity. PET scans are often combined with other imaging tests, like MRIs or CT scans, which incur different costs. You may also need more than one PET scan.

In this scenario, we’ll use a single PET scan as our base for comparison. In 2024, the average Medicare-approved cost for this procedure was $802 at an ambulatory surgical center or $1,422 at a hospital outpatient department.

People with Original Medicare can expect the following costs:

Part B premium. In 2025, you’ll pay $185 per month to keep your Part B coverage.
Part B deductible. You must meet your deductible ($257 in 2025) before Medicare starts to pay.
Coinsurance. Medicare pays 80% of the approved cost of a PET scan. You’ll owe 20%, which could be $161 to $284, according to Medicare averages, saving you $645 to $1,138.
Copayment. If you get a PET scan at a hospital outpatient department, you may have to pay a flat dollar amount, or copay, for your hospital appointment.

Medicare Advantage has a similar cost structure, with some additional factors. Keep in mind that exact costs vary by plan.

Premium. Some plans charge a monthly premium in addition to your Part B premium.
Deductible. You may have to meet a deductible before the plan starts to pay.
Cost-sharing. Like Original Medicare, you may have to pay a coinsurance or copay, but the costs vary by plan.
Out-of-network fees. You may pay more if your PET scan comes from an out-of-network facility.
Out-of-pocket maximum. Unlike Original Medicare, every Medicare Advantage plan limits how much you’ll spend on covered care each year. If you’ve already met your plan’s maximum, you won’t pay anything for a PET scan.

Other Benefits To Consider

If you’re at risk for a condition that can be detected by a PET scan, Medicare covers a variety of other prevention, diagnosis, and treatment services that could make a difference.

Annual wellness appointment. Medicare Part B covers a yearly health assessment with your doctor. This is an opportunity to bring up any new health concerns so your physician can order diagnostic tests.
Other preventive screening services. Medicare covers blood test screenings for cardiovascular disease every five years. These tests can identify heart issues or further testing requirements.
Other cancer screening services. People between 50 and 77 who meet certain requirements can receive an annual lung screening. Medicare also covers an annual mammogram to check for breast cancer.
Other imaging tests. Part B covers CT scans, MRIs, X-rays, and EKGs when ordered by a doctor. CT scans and MRIs are commonly combined with PET scans.

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Putting It All Together

Getting a PET scan is an important step in diagnosing or monitoring diseases that commonly affect older adults, including cancer, heart disease, and brain disorders. Medicare Part B covers PET scans and other imaging tests, which are sometimes performed simultaneously.

If you need more from your coverage or benefits, consider working with a licensed insurance agent or broker to find a suitable Medicare Advantage plan option.