Is PSMA PET CT Scan covered under Ayushman Bharat scheme?

Hello,

Yes, PSMA PET-CT is covered under the Ayushman Card in some cases, but you should not assume that it will be covered as a routine or standalone scan. PSMA PET-CT is a specialised scan mainly used for prostate cancer evaluation, and coverage depends on the applicable PM-JAY package and approval.

The National Health Authority's PM-JAY package list covers cancer treatment through specific packages, and cancer-related packages can require pre-authorisation.

What you should do

First, visit a hospital that is currently empanelled under Ayushman Bharat PM-JAY and provides cancer treatment or nuclear medicine services.

The treating cancer specialist should examine the patient and prescribe the PSMA PET-CT if it is medically required. The hospital's Ayushman desk can then check whether the scan can be approved under the applicable package.

Do not pay for the scan yourself before checking with the Ayushman desk, especially if the scan is expensive.

Proper steps to check Ayushman coverage

1. Open the official PM-JAY hospital search portal.

2. Select your State.

3. Select your District.

4. First check the overall list of Ayushman empanelled hospitals in your district.

5. Check the Government/Private hospital option, where applicable.

6. Select the relevant specialty, such as Medical Oncology or Nuclear Medicine, depending on the options shown.

7. Search for the exact hospital where you want the scan.

8. Enter the captcha, if shown.

9. Click Search and check whether the hospital is currently active under PM-JAY and has the required cancer-related package/service.

10. Visit the hospital's Ayushman Mitra/PM-JAY desk with the doctor's prescription and reports. Ask them to confirm whether PSMA PET-CT is covered under an approved package and whether pre-authorisation is required.

PM-JAY cancer packages can require pre-authorisation, so final approval should be obtained from the hospital's Ayushman desk before the scan.

Documents to carry

• Ayushman Card

• Aadhaar card or another valid government ID

• Cancer specialist's prescription

• Cancer diagnosis reports

• Previous biopsy/pathology reports

• Previous PET-CT, CT or MRI reports, if available

• Treatment records and previous prescriptions

• Hospital referral or treatment plan

• Any pre-authorisation or approval document provided by the hospital

Wishing you and your family good health always.
Warm regards,
Team HexaHealth