Medicare Coverage of an MRI (Magnetic Resolution Imaging)
What It Is
MRI (magnetic resolution imaging) diagnostic testing
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.