PET-CT, or positron emission computed tomography, is commonly used for cancer screening, but it is expensive, and a full-body exam can cost tens of thousands of dollars. Currently, PET-CT examinations are not yet covered by health insurance, so the cost needs to be borne in full by the individual. PET-CT examinations are not covered by Medicare as a whole, although some hospitals may offer reimbursement for this portion of the cost of PET-CT examinations that require an injection of a contrast agent prior to the examination. The Medicare reimbursement process includes confirming reimbursement coverage, collecting reimbursement materials, submitting the materials to the social security department, waiting for review, and receiving reimbursement upon approval. Reimbursement rates vary depending on the type of resident, the level of hospital and whether or not the reimbursement is off-site, but PET-CT exams are usually not reimbursed as they are not covered by Medicare.
Medicare reimbursement scope:
1. Basic medical insurance reimbursement items: including regular outpatient treatment, inpatient treatment, drug costs and some special treatments;
2. Drug reimbursement list: a designated list of reimbursable drugs, which is usually divided into Class A and Class B drugs;
3. Restricted reimbursement conditions: there may be specific reimbursement conditions for certain special treatments or high-value medical services, which are not covered by the medical insurance. value medical services, there may be specific restrictions or additional approvals required;
4. Regional variability: health insurance policies may vary from region to region, and the reimbursement rates and scope may change;
5. Updates and adjustments: the scope of reimbursement and policies of the health insurance will be updated regularly to meet the changes in healthcare services and the needs of the society.
In summary, although PET-CT is an expensive medical test commonly used for cancer screening, and some hospitals may provide reimbursement for part of the cost of injecting the contrast agent, patients are usually required to bear the full cost of up to tens of thousands of dollars on their own as PET-CT examinations are not yet included in the reimbursement scope of medical insurance, a status quo that has limited its application in universal cancer screening.
Legal basis:
The Law of the People's Republic of China on Social Insurance
Article 28
Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facility standards as well as those for emergency treatment and resuscitation shall be paid out of the basic medical insurance fund in accordance with state regulations.