Patient Referral Information

Patients are responsible for payment for the services provided. Usually, insurance will cover all or some portion of payment for services provided. In cases of non-coverage by insurance, patients will be asked to sign an Advanced Beneficiary Notification (ABN) form prior to their procedure.

Before appointments are scheduled we require the following information be provided to us by referring offices:

• Copies of both sides of insurance cards

• A patient information or demographics face sheet

• A written order from your doctor - prescription for the test

• Copies of relevant radiology tests you have already had (CT or MRI)

• Medical Necessity Letter - Physician documentation of medical necessity is required for all Medicare, Medicaid and Anthem patients.

Private Insurance

• Coverage for PET scans varies widely, and should be pre-determined on an individual basis. IU Radiology will seek prior approval before performing exams.

Medicaid Programs

• Medicaid Programs will pay for PET scans, based on medical necessity, as determined by a patients' primary care physician and current coverage status with Indiana Medicaid. We do not accept out of state Medicaid.

CMS/Medicare

CMS / Medicare has strict requirements for PET scan coverage. There are specific requirements for each clinical indication. Check with your doctor regarding individual coverage.