PET scan coverage with medicare

This is my first post, although I’ve been reading her for a few weeks. Thanks to the group running this web site, it’s a great resource. I’m 65, Medicare Supplemental G through AARP. I live in northern NJ.

Diagnosed about 3 weeks ago and need to make treatment decisions.

TURBT showed invasion of muscle layer, according to “local pathologist.” Sent pathology slides to memorial Sloan Kettering and they don’t agree with the original pathologists reading. SO we’re going to do a second TURBT to make sure before they start dissecting me.

Memorial Sloan Kettering surgeon has me scheduled for a PET scan to see if there’s any spread beyond the bladder.

Went to John Theur Cancer center for second opinion, and my oncologist there says PET scan is not really helpful, and that Medicare won’t cover it because it’s not “standard of care.”

Called MSK and out of pocket cost if Medicare declines will be $7500, plus doctors fee. They also told me they thought Medicare would pay for it, and would help with appeals (and a payment plan) if they don’t.

First question: has anyone else had a PET scan and will Medicare cover it?

Second question: if TURBT shows muscle invasion, the bladder will be removed regardless of PET scan. If TURBT is clean and PET scan shows suspicious tumor somewhere else, it’s no longer a bladder issue and I’ll be going to a different surgeon and oncologist.

So is the PET scan a waste of time and money?

I’m also trying to get through to Medicare on the phone to get their answer, but not to hopeful of getting useful information from anything run by the federal government.

Thank I’m advance.