Medicare Coverage of a CT Scan (Computerized Axial Tomography)
What It Is
CT scan (computerized axial tomography), also called "CAT" scan, diagnostic testing
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.