PET scan vs CT scan

Dutch1
Dutch1 Member Posts: 152
in Kidney Cancer #1

I have recently become covered by Medicare (I also carry a supplemental policy).  Today, I learned that Medicare apparently puts a lifetime limit upon the number of PET scans which one can receive in connection with any single cancer.  That is, I can be dealing with RCC for years and be limited by Medicare to 3 or 4 PET scans during that entire treatment period, regardless of how many times the RCC has reappeared. 

Does this sound right?  With a recent recurrence, I've had a couple of PET scans to monitor progress.  My oncologist recommended the PET scan over the CT scan for my situation.  Now, I see that I am coming up against this "lifetime limit".  My understanding is that the PET scan is more beneficial to us as my treatment plan evolves.  I am a little put out that Medicare has seriously limited the use of PET scans for us cancer folks. 

What about it?  What's the general concensus as to whether RCC recurrence can be caught sufficiently early with just CT scans?  Or, as I've been led to believe, is a PET scan much more helpful in early detection?  

Thank you in advance for your input.

 

Dutch

Comments

  • APny
    APny Member Posts: 1,995 Member
    #2
    I was always under the

    I was always under the impression that PET measures bilogical/metabolic activity of a tumor or growth, while CT identifies the tumor structure itself and the size. So I would think a CT would be able to detect small growth. They measure different things: structure (CT) vs function (PET). Or at least that's how it is used in neuroscience with the brain. I'd imagine it's the same elsewhere in the body but of course I could be wrong. I hope you can fight it and get both tests as they obviously work together to get the best results.

  • icemantoo
    icemantoo Member Posts: 3,361 Member
    #3
    APny said:

    I was always under the

    I was always under the impression that PET measures bilogical/metabolic activity of a tumor or growth, while CT identifies the tumor structure itself and the size. So I would think a CT would be able to detect small growth. They measure different things: structure (CT) vs function (PET). Or at least that's how it is used in neuroscience with the brain. I'd imagine it's the same elsewhere in the body but of course I could be wrong. I hope you can fight it and get both tests as they obviously work together to get the best results.

    For what its worth.

    I went on Medicare about 6 years post neph. In fact delayed one scan for a few months to let the Medicare  take effect. No problems ever with approval although for the most part my post medicare scans have been Ultrasounds with a sngle CT.

     

     

    Icemantoo

  • todd121
    todd121 Member Posts: 1,448 Member
    #4
    PET Scans

    I rarely hear of RCC patients getting PET scans. I can't tell you why Dutch. It was explained to me at some point, but it was technical enough it went through one year and out the other. I think it has something to do with how RCC metabolizes compared to other cancers. CT with contrast (or without if it's not available) is the tool of choice for finding early mets in the body, MRI in the brain and a nuclear bone scan for better information for bone mets.

    My oncologist has only ever had me have these 3 types of scans. I've never had a different scan and I've seen 3 medical oncologists that are national experts in RCC (head of the cancer programs at Cedars Sinai, USC Medical school and City of Hope). All are top researchers in RCC.

    You might search through our archives. Neil (user name nanosecond) described this to me as I remember at some point a long time ago. Maybe you can find his explanation? He went through and described the differences in PET/CT/MRI and why one is better over the other. If I can find it, I'll message you the link to it.

    Todd

  • todd121
    todd121 Member Posts: 1,448 Member
    #5
    PET vs CT and Nuclear Bone Scans

    Please read my first post on this thread:

    http://csn.cancer.org/node/252868

    Oncologist #2 in this thread is my current oncologist and he is an RCC expert told me that for bone tumors, a PET scan has a 50% false negative indication and that a CT plus a bone scan is preferred for finding bone mets.

    Maybe there's some usage for PET scans with RCC, but it just doesn't show up here much on this board and I think there must be other reasons for it.

    Todd

  • todd121
    todd121 Member Posts: 1,448 Member
    #6
    And so I did some reading...

    And it appears while what I said is true (PET scans may be controversial for diagnosing new disease or new tumors), for following along with treatment with active tumors, PET may be superior in some ways.

    If you need the PET scans, I can't see how they can say no. Is there a way to appeal or something? If you need them, I think you should be able to get them.

    I've never heard of Medicare giving a max number of anything over a liftetime. Are there other procedures limited like that?

    Best of luck to you,

    Todd

  • pamstayner
    pamstayner Member Posts: 111 Member
    #7
    Hope there is no limit

    I am also on medicare, have been since diagnosis in 2012.  while I had no scans or test prior to the brain met discovered dec. 2013, I have had Pet/CT with or without contrast since Feb. 2014 every 3 months... that makes about 8 of them.  When I was in Oregon for the summer ( of 2015) I had the tests done in Eugene/Springfield so I would not have to travel back to Sacramento, Ca.. just for the test (and not to have to go back to the valley heat just for the test either)  Anyhow, I have not received a bill for any costs for these Pet scans.  The Oregon Oncologist was surprised that I had Pet scans, explaining that the Pet scans did not show things up as well, and did the Pet as it was what the Cancer Center here in Sacramento had been doing, saying to me, I must show up pretty well then.  

    I have Medicare and as a secondary insurance Tricare for life... as the Tricare is also a government coverage, they both have approved the payments (as reduced as their allowables are) and never declined paying.

    Hope that they are not mistaken and come back on it.  I did find this year, that the Tricare coverage for medication has taken some of my blood pressure meds off their list, and wants the Dr. to prescribe something different.

    I will go online and check out the Medicare coverage for Pet scans to see if they are indeed putting on a cap on the number of times.

    Thanks for the heads up Dutch... 

     

  • a_oaklee
    a_oaklee Member Posts: 566 Member
    #8
    No problems so far on Medicare

    Hi Dutch.  We are very happy with the Medicare coverage.  Have never had any problems during the past four years of treatments.  My husband gets CT/PET scans every 3 months for the past four years.  He is now on 6 month intervals.

    Like Todd, we have also been to a couple different RCC specialists at two different large medical centers.  My husband was diagnosed with bone mets and also 1 positive lymph node.  The ct/pet scan is a ct scan overlay of a pet scan.  You have the detail of aa ct scan, combined with the pet scan that looks at whether tumors are metabolically active.  They can measure the size of his bone mets and gauge whether they are active or not.  the same thing is true of lymph nodes.  A CT scan can show a enlarged lymph node, but a CTPET will show whether it is metabolically active.  I haven't read about anyone having a PET scan all by itself.  

    Annie

  • Dutch1
    Dutch1 Member Posts: 152
    #9
    Thanks for the info; it's a confusing situation

    Thanks for relating your experience with PET scans and Medicare reimbursement.  I find conflicting information.  The folks posting here haven't had any problems with getting Medicare coverage for the scans.  My doctor's office is telling me otherwise.  I also have  Pub 100-04 (Medicare Claims Processing) out of the CMS Manual System which talks about a 2015 decision to increase the number of allowed PET scans from 1 to 3 per cancer diagnosis (not "per year", per diagnosis).  That's in addition to the initial PET scan (if used) for the initial diagnosis of the disease.  The publication includes some technical-type talk which suggests that there may be an ability to get additional scans approved via appeal-type procedures.  The language they use is difficult for me to discern exactly what they're saying.  It isn't user-friendly.

    Searching this website (including blogs under all cancer types), I see talk about fighting for coverage of PET scans by Medicare.  Then, the responses to my posted question would indicate that no one has had any pushback from the Medicare people on this issue.

    I'm going to talk to my clinic's people again about this.

    I did call the number on my Medicare card and got someone who told me that PET scans would be covered "no problem".  I think she was a little quick with that answer.  I'm not willing to rely on it yet.

    Thanks again, evryone.  I do appreciate the info that I gather from you.

    Please take care.

     

    Dutch

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