Insurance Coverage

Most insurance companies pay for clinically indicated PET and PET/CT procedures. To be clinically indicated, the procedure must be potentially beneficial in providing information supportive of a diagnosis or monitoring certain conditions.

Private Insurance
Generally, most private insurance companies cover the same indications as Medicare, although some may cover more indications and some may cover fewer indications. Private payers can have wide variations in coverage policies, coverage criteria or procedures. The referring physician and the imaging center work together to verify specific local coverage guidelines and to obtain pre-authorization prior to performing the scan.

Medicare
The Centers for Medicare and Medicaid Services (CMS) coverage policies for PET and PET/CT indications are decided at a national level and are documented in a National Coverage Determination (NCD), section 220.6 Medicare Covered Indications.

National Oncologic PET Registry (NOPR)
The National Oncologic PET Registry (NOPR) was developed in response to the Centers for Medicare and Medicaid Services (CMS) proposal to expand coverage for FDG PET to include cancers and indications not presently eligible for Medicare reimbursement. Medicare reimbursement for these cancers is available if the patient's referring physician and the imaging provider submit data to a clinical registry to assess the impact of PET on cancer patient management. The NOPR implements this registry for CMS.

Please contact our office with questions regarding insurance and coverage for PET scans.

NCPIC is a not-for-profit, community benefit organization committed to providing the most advanced level of PET/CT imaging services. NCPIC was established in 1992 as the first freestanding non-university PET center in the nation and continues to be a nationally known center of excellence.

"Patient Preparation for your Scan"

Expanded Medicare PET Coverage

Expanded Coverage Table

What's New at NCPIC?
NCPIC News
NOPR News

Positron Emission Mammography (PEM) is here!

PEM Patient Testimonial

Locations:
Main Facility Midtown Sacramento
Roseville Sutter Roseville Medical Center
Carmichael Mercy San Juan Medical Center
Fairfield NorthBay Medical Center
Woodland Woodland Healthcare
Grass Valley Sierra Nevada Memorial Hospital

Hours:
Monday - Friday 7:00am - 5:00pm
(National holidays observed)

Scheduling for ALL Locations:
916-737-3211
888-PET-3211 or 888-738-3211
Fax: 916-737-6203

Downloadable Forms:
PET/CT Scan Request
Diagnostic CT Request
Medicare Brain PET Scan Request
NOPR Clinical Indicator Table
M-Care Dementia Guidelines
Patient Instructions
Why Proper Preparation is So Important
"What Should I Expect During My Scan?"
Insurance and Payer Contracts
HIPAA Notice of Privacy
Patient Consent Forms

Contact Us and Meet our Experts:
PET Physicians
Administration
Support Staff
Technologists