Medicare PSMA scan coverage

Hello fellow fighters. I got 2 questions. I've recently had a PSMA scan which showed mets in my pelvic region. 2 clusters of 4 and 1 in the middle. I had complete RALP failure with PSA 2 months after surgery at 2.9, which leads me to believe I had a good chance of nodal invasion back in 2011-12. IGRT and 6 months of Lupron helped me limp to the present day.

Question one: I know Medicare recently lifted its 2 Pet Scan lifetime limit. So what is it now? Got one Pet this year, can another one be covered next or sooner?

Question two: Anyone have experience with radiation of lymph nodes? I have had radiation to the prostate bed but not the nodal areas. (I think back in 2012, even with cat guided radiation it was a bad idea, plus, RALP never removed any nodes for check up. Have an appt with the Northwest Proton Center in Illinois to see if feasible.)

Thanks you all in advance for any guidance or comments.

Thank you Mumbo. Yes, after Northwestern, may try Mayo.

Thanks JNF!

I have a Medicare Supplement so when I have called Medicare, they have always used the term "medically necessary as determined by your doctor" like rancherdave indicated. I am sure they have limits for certain things but I have not run into many in over 5 years. If they do, the doctors seem to know that and have work arounds.

However, I cannot speak for Medicare Advantage Plans where the calls go to an Insurance company. I suspect that is the usual crapshoot depending on you talk with.

OK, I think I understand. I have medicare plan G from Mutual of Omaha which was the best I could get when I enrolled 4 years ago. Glad I did cause now I need it.