PSMA scan and Medicare

Would anyone happen to know if traditional Medicare ( A&B ) covers a 68Ga-PSMA scan? I'm getting conflicting reports. Thank you.

[Tall_Allen]

No it definitely does not. It is not even FDA approved yet. Medicare may cover it after FDA approval, but not before.

[billw16]

I had the scan at the University of Michigan it was a Clinical Trial and Medicare and supplement cover all the cost since it was a clinical trial.

[Break60]

It has not been FDA approved. The scan is covered but not the radiotracer. But interestingly I was told at UCSF that the tracer would cost about $900 but I’ve never been billed! I’ve heard that it is in the process of being approved. Also some hospitals who don’t have funding for a trial make you pay for the scan as well as the tracer. For example back in October 2018 MSKCC wanted to charge me about $7500!

You need to shop around for trials to get their pricing.

[j-o-h-n in reply to Break60]

" but I’ve never been billed!" shhhhh

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 09/27/2019 2:55 PM DST

[Casper3]

I had a PSMA scan in December of 2017 at mskcc. I thought that it had just been approved or that they had just started a study. But anyway i had to sign a paper that if insurance didn’t cover it I would have to pay around $7000. I thank god that I never got a bill so whether they covered it or the insurance did I don’t know but I’m thankful.

[Teddy28 in reply to Casper3]

Casper3 - just wondering if MSK submitted the bill to Medicare or other insurance? I just had similar scan and Medicare denied claim, not surprisingly.