Medicare Coverage of X-Rays
What It Is
Medicare Part A covers X-rays of an inpatient in a hospital or skilled nursing facility. For an outpatient, Medicare Part B covers X-rays ordered by a physician for the purpose of diagnosing a medical condition. Medicare doesn't cover X-rays ordered for preventive screening.
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 X-rays, contact the plan directly.
What Medicare Pays
For a hospital or skilled nursing facility inpatient, Medicare Part A pays X-ray costs under the same payment rules as for any other hospital charge. See What are Medicare Part A and Medicare Part B premiums, deductibles, and coinsurance amounts in 2009?
For X-rays taken in a doctor's office, clinic, or other X-ray laboratory not part of a hospital outpatient department, Medicare Part B pays 80 percent of the Medicare-approved amount.
**Warning:** If X-rays are taken in a hospital outpatient laboratory, the patient may be personally responsible for a co-payment to the hospital above the Medicare-approved amount, in addition to the 20 percent of the Medicare-approved amount that Medicare doesn't pay.
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.