Approximately two million PET/CT scans are performed annually in the United States. PET/CT scan pricing is approximately two times the price of a CT scan alone. Additionally, there are significant downstream costs due to the prevalence of false positives.
PET/CT (position emission tomography/computerized tomography) scans are imaging studies that display abnormal metabolic activity. The scans are used in tumor patients for baseline staging, treatment response evaluation and surveillance. Coverage guidelines for PET/CT scans vary significantly between Medicare, Medicaid and Commercial plans. Commercial coverage often depends on tumor type, state of disease and clinical setting as set forth in NCCN’s national guidelines. Oncology Analytics’ oncology PET/CT specialists understand the nuances of coverage. If a PET/CT scan is not covered by a patient’s plan, Oncology Analytics’ specialists collaborate with the ordering physician to determine if variables exist to justify coverage.