Medicare Coverage of an MRI (Magnetic Resolution Imaging)

What It Is

MRI (magnetic resolution imaging) diagnostic testing

What's Covered

Medicare Part A covers an MRI diagnostic test performed on a hospital or skilled-nursing-facility inpatient.

Medicare Part B covers an MRI performed on an outpatient, in any setting, to diagnose an illness or injury.

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 an MRI, contact the plan directly.

What Medicare Pays

If a hospital or skilled-nursing-facility inpatient receives an MRI diagnostic test, 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 an MRI diagnostic test is performed on an outpatient, the amount Medicare Part B pays depends on the setting in which the MRI is provided. If the MRI 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 MRI 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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3 Comments So Far. Add Your Wisdom.

almost 2 years ago

I agree with robinhood, and hope for the best of tests for missyprissy. I think I need an MRI. Doctors and physical therapists cannot agree with what is wrong with my leg. The first said, "Let's try..." That comment combined with a cost of $200 for the cream caused me to skip this treatment. The next doctor took Xrays of my hips, though I had told him the pain was in my left thigh. Hips are fine. Next he sent me to physical therapy. The first therapist sounded logical when she showed me a chart of the 2nd vertebrae that covered the same area of my thigh where the pain jumps back and forth. It seems like the pain is getting worse and lasting longer. The next therapist doubts it's my vertebrae. In just the last couple of days I've got a new pain that keeps me up at night. It's on the same leg just outside my knee. Sort of in line with the worst of the thigh pain. I found out how much the therapy is costing me since I don't have a supplementary insurance. Only medicare. I've called to cancel the rest of my appointments, and am looking for an MRI. I need answers rather than hit and miss treatments. I also have a pain in the middle of my upper back that hits me like one of those horizontal flat lines you see in moves when I cough or sneeze. If anybody knows anything, I would certainly appreciate information. Sharra (Share-a)

almost 3 years ago

What they want is for use to die, to save the money. reminds me when i was in the service Number 50 down just step over. IT'S ALL ABOUT THE MONEY.

about 3 years ago

I have been to our local hospital during the past year to have mammograms, and sonograms, Yet, the pictures have not shown what the doctor is looking for. I have several cysts, and calcifications, which had changed within a year(from 2010 to 2011). The gentlemen who read the pictures were quite alarmed that such a changed had taken place in just a year. So now I am scheduled for an MRI of both breasts this week. My only concern is if medicare will cover the MRI, or not. I am on Government disability and have no assets with which to pay for something this expensive.. Could you help me to understand what exactly medicare will pay for and what would it cost me if it isn't covered. My local hospital couldn't see what the spot was to make an exact diagnosis for me as well as for my doctor. Small town hospitals don't have the money to afford the advanced medical equipment needed for such a test. I also spent 10 years with a broken hip, due to the fact that the equipment was not accurately up to date to see the break, or the necrosis of my ball and socket. I need to know the answers soon where this cancer warning is concerned. I just want it to be caught as early as possible.


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