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FES PET/CT scan insurance coverage


Has anyone with traditional Medicare had a FES PET/CT scan? I can’t get a definitive answer on payment for the procedure from either the hospital or CMS. Both say that an FDG PET/CT is covered so the answer is “probably.” Given the cost (more than FDG) I’m worried about having it done without knowing for sure.

After two MRIs a 25x13x22 mm spot in my posterior acetabulum has been diagnosed as a met or a benign bone lesion which mimics one. My MO said that an FDG PET is sure to light up because of the inflammation and degenerative changes that can be seen on the MRIs. She is hesitant to biopsy because of likely damage to the hip joint and would make a diagnosis on uptake. When I asked about receptor conversion she said that with no FES uptake the lesion would be monitored by MRI. This plan makes sense to me but the six insurance denials I had to fight in the past (pre Medicare) make me pause.

Thanks in advance for any information.