Does Medicare cover PRRT with Lutathera for neuroendocrine tumors, and what will I pay out of pocket?

Question

Sam Pak · Accepted Answer

Yes, Medicare may cover PRRT (Peptide Receptor Radionuclide Therapy) using Lutathera for certain types of neuroendocrine tumors, provided the treatment meets Medicare's medical necessity and coverage requirements. Lutathera is a targeted radioactive treatment generally used for specific tumors that have somatostatin receptors.

What you pay out of pocket depends on your Medicare coverage. Under Original Medicare, Lutathera is generally covered under Part B when administered as an outpatient treatment. After meeting the Part B deductible, you typically pay 20% of the Medicare-approved amount, unless you have supplemental coverage that helps pay those costs.

If you have a Medicare Advantage plan, your costs will depend on the plan's medical benefits, copays or coinsurance, and annual out-of-pocket maximum. The plan may also require prior authorization, so it's important to verify coverage before beginning treatment.

Because PRRT is a specialized and potentially expensive cancer treatment, I would recommend confirming that both the treatment and the medical facility are covered, along with any additional costs for imaging, laboratory tests, and related services.

As a Medicare agent, I believe it's important to look beyond monthly premiums and extra benefits, especially when someone is dealing with a serious medical condition. Understanding the coverage details and potential out-of-pocket expenses can make a significant difference when choosing a Medicare plan.

Anna Crichton · Answer

Yes, Medicare covers Peptide Receptor Radionuclide Therapy (PRRT) with Lutathera when it is medically necessary for FDA-approved indications. Because Lutathera is an intravenous radiopharmaceutical administered in a clinical setting, it is billed under Medicare Part B rather than Part D. 
Since this is a drug that is delivered through an IV and a licensed healthcare provider must be the one to administer the prescription if you are on a Medicare Advantage Plan you would be responsible for 20% coinsurance up to your Maximum Out Of Pocket (MOOP) amount for the plan. If you are on a Medicare Supplement you would be responsible for the Part B deductible and then $0 for the remainder of the year.

Latoia Walker · Answer

Yes, Medicare covers PRRT using Lutathera for eligible neuroendocrine tumors. If you have Original Medicare you would pay a 20% coinsurance. If you have an Advantage plan you would pay the copay or the coinsurance stated by your plan in the summary of benefits. If you have a Medicare Supplement plan, the 20% is covered once you hit your annual deductible for the year ($283/annually for 2026).

Answered by Latoia Walker on November 9, 2026

Broker Licensed in FL

Answered by Latoia Walker Medicare Insurance Agent

Angel Cayocca · Answer

Generally yes. However, you are responsible for 20% after part B deductible whitch has no cap so it can become expensive.

Does Medicare cover PRRT with Lutathera for neuroendocrine tumors, and what will I pay out of pocket?

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Does Medicare cover PRRT with Lutathera for neuroendocrine tumors, and what will I pay out of pocket?

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