What does a PSMA PET Scan cost?

All PET scans are billed utilizing two codes — one for the scan itself, the other for the tracer injected into the patient.  In 2022, CMS first provided dedicated billing codes for PSMA tracers PSMA, Illuccix and Locametz.  With dedicated billing codes for those tracers, CMS also provided reimbursement for those tracers.

Third-party insurance companies often follow Medicare, and as a result, most have already added these PSMA tracers to their formulary and are providing reimbursement for their use.  As a reminder, determination of insurance coverage is specific to your individual history, needs, coverage, and insurance plan.

In all cases where a PSMA PET scan is not covered (or when an authorization is denied) by your insurer, you should reach out directly to your insurer to ask for a special case to be made.  There is not a guarantee of coverage, but it is possible that you and/or your physician may be able to persuade your insurer to cover the scan AND the tracer cost.

Patients without insurance coverage (or when an authorization is denied) have an option to pay cash for the scan.  The total charge is comprised of two components.  The actual PET scan portion is our standard $1,000 charge.  The cost of the PSMA “tracer” or the material we inject to perform the scan, is set by the manufacturer and is -approximately- $5,000.  Your exact cost will be provided to you beforehand, and we -never- have hidden fees or surprise bills.

Please note, as a contracted facility with most medical insurance carriers, we are obligated to abide by contractual insurance guidelines.  Therefore, our cash price offer can only be extended to those patients who do not have coverage.

For further details, please call 954-981-6668 or email: psma@piisf.com.  Already have a prescription for a PSMA PET Scan?  If so, you may fax it to our PSMA Fax Hotline:  (954) 607-6757.