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Thread: How many times can you have a petscan a year?

  1. #1
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    How many times can you have a petscan a year?

    My mom was denied her pt scan from the Medicare Her last scan was in May 2013 showed tumors were shrinking. Finished her chemo of Abraxine and Gemside. So Dr wants to see how she is doing should she take a chemo brake or take pill form chemo Zeloda............. Well we are now tring to get ct scan aboved and done before Drs appt on the 13th of Septmeber it just sucks!! So has anyone else been denied? Is there a time limit from scan to scan. Dr is confident that ct scan with contrast will show good enough results. All I know 2x she had ct scan in hospital and they thought the cancer spread to the bones and other areas and it was inconculsive so...... ist this a game or what??

    Fustrated with insurance companies!!! xo Cathy

  2. #2
    Senior User DeeJM's Avatar
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    Cathy,
    I think Medicare only allows one pet scan a year. Does your mom have secondary insurance? I don't know if this Medicare rule is new due to Obamacare. If I find anything for sure I ll let you know. Hopefully the ct will show what is needed. Good luck.
    Be strong and God bless.
    Dee

    Moms cancer history: current age 84 she made it Nov 8th! Very excited
    1994 breast cancer
    2011 Jan dx with colon cancer
    2011 Sept colon resection, no recurrence
    2012 Dec PET scan showed metobolic activity in pancreas
    2013 July PET scan showed increased activity in pancreas and mets to liver. Liver biopsy confirmed pancreatic cancer.
    2013 Aug 28th she wanted to try chemo of Gemzar and Abraxane.
    Two treatments then no more. It was too toxic for her.
    October 2013, feeling much better. Maybe the chemo is finally out of her system. Enjoying family visitors while she is feeling very well. We'll take it!
    Nov 2013, subtle changes,decreased appetite, sleeping more
    Dec 2013, very weak, short of breath, eating less
    Jan 2, 2014 home Hospice began.
    Jan 18, 2014 mom passed.

  3. #3
    Senior User DeeJM's Avatar
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    I just found an article that's says it was going to be one but the final decision was for 3.


    Decision Memo for Positron Emission Tomography (FDG) for Solid Tumors (CAG-00181R4)
    From www.cms.gov/medicare-coverage

    Decision was June 11,2013. Someone needs to make sure they are using current dates in the request for approval. I would be calling the Dr office right now.

    Good luck.
    Be strong and God bless.
    Dee

    Moms cancer history: current age 84 she made it Nov 8th! Very excited
    1994 breast cancer
    2011 Jan dx with colon cancer
    2011 Sept colon resection, no recurrence
    2012 Dec PET scan showed metobolic activity in pancreas
    2013 July PET scan showed increased activity in pancreas and mets to liver. Liver biopsy confirmed pancreatic cancer.
    2013 Aug 28th she wanted to try chemo of Gemzar and Abraxane.
    Two treatments then no more. It was too toxic for her.
    October 2013, feeling much better. Maybe the chemo is finally out of her system. Enjoying family visitors while she is feeling very well. We'll take it!
    Nov 2013, subtle changes,decreased appetite, sleeping more
    Dec 2013, very weak, short of breath, eating less
    Jan 2, 2014 home Hospice began.
    Jan 18, 2014 mom passed.

  4. #4
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    Thanks dee I am calling in the morning

  5. #5
    Super Moderator Top User DebbieC's Avatar
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    Good luck...dealing with insurance companies can be so frustrating. I should know...I used to work for one.
    March 21, 2011 - Dad diagnosed. Pancreatic Adenocarcinoma on head of pancreas.
    April 2011 - Gemcitabine and radiation for a total of 12 weeks.
    October 14, 2011 - Successful Whipple procedure. Cancer free! Best 5 months of my life!!!
    March 2, 2012 - CT scan and discovery of possible mets to both lungs.
    March 23, 2012 - Biopsy confirmed recurrence.
    May 2, 2012 - Folfiri regimen started. Stopped after 2 treatments due to infection.
    June 2, 2012 - Switched to Xeloda
    Sept. 21, 2012 - No more chemo...treatment not working anymore. Now we wait and pray.
    October 6, 2012 - My dad is now at peace in Heaven, watching over us until we meet again.

    ♥ Forever in my heart! Miss you every day more than words can say! ♥

  6. #6
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    Our insurance company has approved everything, until we asked for a PET scan. They denied us stating that PET scans are used for diagnostic purposes and that only a CT scan would be approved at this point, because he is already diagnosed. Our caseworker told our oncologist she could appeal easily by stating that she is checking for metastasis, the oncologist refused, stating that a CT scan is enough. I was so disappointed, I really wanted to "see" the cancer and if it spread. I do not even know how to look at a CT image, even though they mail us a cd of it each time they do one.
    4/13: hubby to er w/ 7 cm mass on pancreas, total bilirubin 7.1 Temporary biliary drain.
    4/13: Unable to perform biopsy using ERCP, Rad. Int. took needle/brush biopsy; referred to Mayo Clinic in Phoenix AZ
    5/13: Mayo. Stage 3, borderline resectable. SMA/SMV are "involved", recommend reduce with Folfirinox, return in 3 cycles to reassess. whipple is goal.
    5/13: Mayo installed a 10 French Stent.
    5/22/13: first Folfirinox administered, no side affects
    6/5/13: Received a final report from Mayo team, after 3rd round they want to look and see if he is a candidate for radiation/chemo.
    7/13: CT scan showed not change to tumor after round 3 was completed.
    7/13: going on round 5, pain and tiredness are taking over his body. About 10 days before he can get off couch after chemo.
    8/13: round 8 this week then a chemo vacation! PET and CT at end of Sept.
    9/13: Mayo, biliary stent blocked and Ascites began. ERCP, ascites pending testing, hoping for great news.

  7. #7
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    Hopefully someone else will chime in, but from my limited knowledge, CT scans do allow the doctor to monitor the size of the existing tumors. In fact though you can see cancer and inflammation with a PET scan, they don't usually measure the tumors on that scan---the CT scan may actually be more informative to the doctor. I would ask him at your next visit. Prayers for good scans.

    Amanda
    Caregiver to son, 32 , 5/18/2011 Stage IV
    Sigmoid colectomy , liver biopsy 5/18/2011
    6cm sigmoid tumor, low grade (well-to-mod. differentiated)
    6 of 33 lymph nodes +
    FOLFOX /Avastin 6/2011-8/2011
    Rt hepatectomy on 9/20/2011---70%
    2012
    FOLFOX /Avastin 4 cycles 1/31 stopped-low platelets
    3/5 CT clear
    4/ PET scan showed peritoneal mets
    4/24 splenic embolization for low platelets
    FOLFIRI/ Avastin 5/12-8/12
    Consult for HIPEC 8/12 denied---tumors too many, possibly in ureter.
    5FU/ Avastin 8/2012-2/2013
    12/5/12 scan tumors stable
    12/12 aranespt
    2013
    3/5 tumor progression in abdomin
    Restart FOLFIRI/ Avastin with lower dose of Irinotecan 3/11-3/25
    nuelasta shots
    ER - bowel obstruction 4/4
    Port removed 4/12
    Port replaced 5/9
    ER 30 hrs
    Erbitux in, Irinotecan lowered 5/20 & 6/17
    9/17scan indicates stable
    9/18-27 & 10/7-11 small bowel obst.
    Erbitux & Irinotecan 11/5, 12/2
    Bowel obst. 12/31
    2014
    1/8 urether stent
    1/17 Hospice
    3/27 started his new journey

  8. #8
    Administrator Top User ChemoMan's Avatar
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    A CT scan does indeed show more detail than a PET scan. To try and get detail into a PET scan it is usually combined with a low dose CT scan anyway. For a skilled physician the CT scan is as good as if not better than a PET. A PET scan does not detect cancer it only measures metabolic activity within the body so it is not specific to cancer at all where as a CT scan will be able to actually visualize the tumors and show any progression in greater detail.

    PET are horrendously expensive hence the insurance companies reluctance to pay for it. The costs in your case are not warranted especially considering that a CT would probably give your doctors more information on how things are progressing.

    I hope that helps and good luck
    Age 57
    Diffuse Large B cell Lymphoma
    Stage 2a
    Finished six cycles of R chop 21 26th May 2008
    Officially in remission 9th July 2008
    Remission reconfirmed 1st October 2008
    Remission reconfirmed 17th June 2009
    Remission reconfirmed 7th June 2010
    Remission reconfirmed 6th July 2011
    NED on the 2/01/2013
    No more scheduled visits to the Prof
    http://cancerforums.net/viewtopic.php?t=9620

    RULE NUMBER 1.....Don't Panic
    RULE NUMBER 2..... Don't forget rule Number 1

    Great moments often catch us unaware-beautifully wrapped in what others may consider a small one.

    I may not have gone where I intended to go,
    but I think I have ended up where I needed to be.

 
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