Insurance/managed-care plans, Medicare, and Medicaid reimburse for PET and PET/CT on a case-by-case basis, depending on the patient's diagnosis. The Columbia Kreitchman PET Center staff can work with referring physicians and their patients to verify benefits and pre-authorizations, if needed. Coverage may depend on the specific indications and private insurers may require pre-authorization.

Medicare’s expansion of oncology/PET coverage

While Medicare routinely covers PET scans for selected cancers (breast, colorectal, esophageal, head and neck, non small-cell lung, lymphoma, melanoma, and thyroid), a patient can now receive coverage for virtually all other cancers by participating in Medicare’s National Oncologic PET Registry (NOPR). The NOPR is actually a research study designed to validate PET’s effectiveness as a part of cancer treatment management.

The Columbia Kreitchman PET Center is a registered site for the National Oncologic PET Registry (NOPR).

For cancers covered under the NOPR, Medicare requires completion of two brief care-management surveys. We are committed to streamlining NOPR enrollment for referring physicians. Our staff, who can be reached at 212-923-1555 (or by fax: 212-923-2821), will walk you and your office through the enrollment process, providing all necessary forms with patient information filled in, and assisting you in meeting Medicare’s stringent timeline for submission. (You may read more about the NOPR by visiting www.cancerPETregistry.org.)

Meanwhile, coverage of the routine cancers remains unchanged: as long as your office executes our standard intake requisition, neither you nor your patient will need to take any further steps to obtain Medicare coverage. In addition, PET/PET CT is covered by many private insurers, which reimburse for PET on a case-by-case basis. Our staff is always available to work with physicians and patients to verify benefits and submit claims as needed.

Click here to download a copy of the NOPR official coverage key.

For your reference, download copies of the NOPR pre-PET and post-PET forms. Please keep in mind that our office will provide this paperwork to you as part of the process of registering your patient.