Is PSMA PET-CT Covered — by Insurance or Aarogyasri?

Not automatically. FDG and PSMA are different tracers classified under different procedure codes, and approval of one does not extend to the other. You need to apply for pre-authorisation specifically for PSMA PET-CT, with an oncologist letter explaining the clinical reason it was chosen over FDG. Some insurers have approved PSMA PET-CT under a general PET-CT category once clinical necessity was established in writing — but it requires a separate application, not an assumption.

Reimbursement claims are possible, but the chance of approval is lower without prior authorisation. Some insurers refuse reimbursement for procedures not pre-approved, even when the clinical indication is clear. If you are considering paying upfront, contact your insurer in writing before the scan and document the response. That written record is your protection if the reimbursement is later disputed.

The letter should explain why PSMA PET-CT was requested, why FDG PET or conventional imaging could not answer the same clinical question, and what treatment decision the scan result will inform. It should note that the recommendation is consistent with ASCO or ESMO guidance on prostate cancer imaging. The more specific the clinical reasoning, the harder the claim is to refuse on administrative grounds. A generic letter saying 'PET scan required' is not sufficient.

PSMA PET-CT does not yet have a single standardised procedure code that all Indian insurers use consistently. Ask your imaging centre what code they will use on the invoice, and ask your insurer what code they expect on the claim form — then confirm the two match before the scan. A mismatch in codes is a common reason for refusal that has nothing to do with clinical merit, and it is much harder to correct after the scan is done.

CION coordinates PSMA PET-CT through partner imaging centres at an indicative cost of around ₹23,999 as of 2025 — confirm the current figure when booking, as availability and tracer supply are confirmed at that point. No guarantee of insurance coverage can be given before written pre-authorisation is obtained. If cost is a concern, discuss the timing of the scan with your oncologist.

The clinical team at CION can provide the referral letter, diagnosis summary, treatment history, and supporting records your insurer requires. Ask at your centre and allow a few days for the documents to be prepared. The administrative filing — submitting forms to the TPA or insurer — is your responsibility, but the clinical documentation is something your treating team can support.