Medicare Coverage of a CT Scan (Computerized Axial Tomography)


What It Is

CT scan (computerized axial tomography), also called "CAT" scan, diagnostic testing

What's Covered

Medicare Part A covers a CT scan performed on a hospital or skilled nursing-facility inpatient. Medicare Part B covers a CT scan performed on an outpatient in any setting.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for a CT scan, contact the plan directly.

What Medicare Pays

If a hospital or skilled nursing facility inpatient receives a CT scan, the cost becomes part of the overall charges that Medicare Part A pays according to its schedule of inpatient coverage, which includes a deductible and co-payments for lengthy hospital stays.

If a CT scan is performed on an outpatient, the amount Medicare Part B pays depends on the setting in which the scan is provided. If the scan is performed in a doctor's office, freestanding clinic, or independent testing facility, Medicare Part B pays 80 percent of the Medicare-approved amount. If the scan is conducted in a hospital outpatient department, Medicare Part B pays the full Medicare-approved amount, except for a set co-payment that the patient is responsible for.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

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6 Comments So Far. Add Your Wisdom.

2 months ago

Does Medicare now pay for SCREENING lung CT scans?


5 months ago

There is no information that definitely say that Medicare will cover a cat scan for possible lung cancer when the physician's assessment indicate a Solitary Pulmonary Nodule.


7 months ago

Is there a limit on the number of ct scans, that are medically necessary, that Medicare will pay fr?


Anonymous said almost 2 years ago

I am fighting breast cancer, I will be starting on medicare in July, and cancer doctor has ordered a Ct scan on the last of Aug,2012 and I will see cancer doctor on Sept.2012, will Ct scan be covered?


almost 3 years ago

Hi Kay, Thanks for your question. Each state runs its own version of Medicaid, with slightly different rules and coverage. To get one on one advice about Medicaid, contact a government health insurance counselor. You can find your local government health insurance counselor in our local directory: ( http://www.caring.com/local/government-health-insurance-counselors ). If you'd like to learn more about Medicaid, check our our article How Medicaid Works: ( http://www.caring.com/articles/how-does-medicaid-work ). I hope that helps!


almost 3 years ago

I am trying to find out if there is any time limit -- i.e., number of months between CT scans -- for which Medicare does not pay. My doctor has ordered a CT scan during the week of 6/6/11 and my last scan was 12/21/10, which means it is a little less than six months between the two. Will Medicare cover the cost?


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