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Does Medicare pay a MRI? If so, how many MRIs will Medicare cover in a year?

4 answers | Last updated: Sep 26, 2014
An anonymous caregiver asked...
Will Medicare pay for more than one MRI in a year in the same area?

Caring.com User - Joseph L.  Matthews
Caring.com Expert
Joseph L. Matthews is a Caring.com Expert, an attorney, and the author of Long-Term Care: How to Plan & Pay for It and...
74% helpful

There is no special Medicare rule limiting the number of MRI exams it will cover for a patient in one year. Whether Medicare Part Bmedical insurance will pay for See also:
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any MRI – or for any other medical service -- depends on Medicare's determination that it is "medically necessary." In your case, that depends on how well your doctor explains to Medicare why your second MRI on the same area is necessary. There are certainly plenty of legitimate reasons to have more than one MRI, so your doctor might not have any problem getting Medicare authorization. Discuss with your doctor the question of Medicare authorization for the MRI. If your doctor expresses any doubt that Medicare will cover your second MRI, make sure to have the doctor go through the official Medicare paperwork and receive actual approval before you have the MRI exam.


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83% helpful
LindaSD answered...

Medicare has a great website: http://www.medicare.gov/Coverage/Home.asp

You can key in your id# or state and choose what kind of benefit you want to review. Your ID is better because it will include the benefit level you are paying for (Part A and B).

I use this all the time. The main site also has a listing of covered preventive care item.

The Answer you go is correct in getting the doctor to submit it prior to doing the test. My mom had an MRI given by a family doctor, he referred her to a specialist, and the specialist ordered a second one without even looking at what was sent by the first doctor. If I hadn't said something, she would probably have been stuck with paying for it since there was no reason for the second one. The first one was all the second doctor needed to know.

Follow the answer given and check out the website.


Dianew answered...

I had a knee MRI and Medicare denied it because they said they do not cover things that are not approved by the FDA! REALLY? I am appealing that decision. It was the first one I had


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