How much does a CT scan cost with Medicare?

The Medicare-approved amount for a CT scan varies widely by the specific type of scan, facility location, and whether it is done in a doctor's office or a hospital.

Average Costs for Common CT Scans

National averages for the total Medicare-approved amount depend on the procedure code:

• CT Scan (e.g., specific code 78815): The national average total Medicare-approved amount is $1,569 (including a $109 doctor fee and a $1,460 facility fee). Original Medicare pays 80% ($1,255), and you pay 20% ($313) if you met your deductible.
• Other Scans (e.g., code 70553): The national average total Medicare-approved amount is $672 (including a $316 doctor fee and a $356 facility fee). Medicare pays 80% ($538), and you pay 20% ($134).
• You can search specific procedure codes on the Medicare Procedure Price Lookup tool.

What You Pay Out-of-Pocket

• Part B Deductible: You must pay the annual Part B deductible first before Medicare starts paying its share.
• Coinsurance: After your deductible, you generally pay 20% of the Medicare-approved amount for outpatient scans.
• Facility Fees: If you get the scan at a hospital outpatient department, you might owe a separate hospital copayment in addition to the 20% coinsurance.
• Medicare Advantage: If you have a Medicare Advantage Plan, your cost is usually a flat copayment instead of 20%.

Yes, Medicare pays for a CT scan if a doctor orders it because it is medically necessary to diagnose or treat a medical problem, or if it meets specific rules for preventive screening.

How Coverage Works

• Part A: Covers your CT scan if you get it while admitted as a hospital inpatient or during a stay in a skilled nursing facility.
• Part B: Covers your CT scan if you get it as an outpatient in a doctor's office, independent testing facility, or hospital outpatient department.
• Part C (Medicare Advantage): Covers CT scans too, though you must use network providers and follow your plan's rules.
• Preventive Scans: Medicare covers certain preventive CT scans, such as annual lung cancer screenings for high-risk individuals and periodic CT colonography screenings.

What You Pay

• Original Medicare Part B: After you meet the annual Part B deductible ($283 in 2026), you generally pay 20% of the Medicare-approved amount.
• Hospital Outpatient Departments: If your outpatient scan is done at a hospital, you may also have to pay a separate hospital copayment.
• Part A Inpatient: You pay the inpatient hospital deductible per benefit period ($1,736 in 2026) if applicable, after which Part A covers the rest of the costs for approved care.
• Supplemental Insurance: Medigap or supplemental plans can help cover these remaining out-of-pocket costs like coinsurance and deductibles.

No, a CT scan is not fully covered for free by Original Medicare unless it is a specific preventive screening like a yearly lung cancer check for eligible high-risk patients.

For most diagnostic CT scans, Medicare helps pay the costs, but you still have out-of-pocket expenses.

How Original Medicare Covers CT Scans

• Outpatient Scans (Part B): Covered under Diagnostic non-laboratory tests if your doctor says it is medically necessary. You pay the annual Part B deductible ($283 in 2026) plus 20% of the Medicare-approved amount. If you go to a hospital outpatient department, you might also owe a facility copayment.
• Inpatient Scans (Part A): Covered if you are formally admitted to a hospital. You pay the Part A deductible ($1,736 in 2026), after which Part A pays the full cost for covered services during your stay.
• Preventive Scans: Fully covered at no cost only for annual lung cancer screenings using low-dose CT if you meet strict age, smoking history, and ordering criteria.

Other Insurance Options

• Medicare Advantage (Part C): These private plans must cover everything Original Medicare does, but your copays or coinsurance will vary by plan and include an annual out-of-pocket maximum.
• Medigap (Supplemental Insurance): Helps pay remaining out-of-pocket costs like the 20% coinsurance or deductibles.

Original Medicare does not require prior authorization for most outpatient CT scans, but private Medicare Advantage plans frequently do.

Original Medicare (Parts A and B)

• Approval rule: Prior authorization is generally not required for outpatient CT scans ordered by a Medicare-enrolled doctor for medical reasons.
• Facility rules: The test must be done at a Medicare-approved facility, and the provider must follow standard coverage rules.
• Cost: After you meet your yearly Part B deductible, you usually pay 20% of the Medicare-approved amount for the service.

Medicare Advantage (Part C)

• Approval rule: Private insurance companies that run Medicare Advantage plans often require prior authorization before they will pay for a CT scan.
• Rules vary: Each private plan sets its own list of covered services and approval steps.
• Action: Check your specific plan's rules or call the phone number on your member ID card before your appointment.

Original Medicare does not cover several major healthcare services, most notably routine dental care, hearing aids, routine vision care, long-term custodial care, and overseas medical care.

Major Uncovered Services

• Routine Dental Care: Original Medicare does not pay for routine cleanings, fillings, tooth extractions, root canals, or dentures, except in rare surgical circumstances related to specific medical treatments.
• Hearing Aids: Routine hearing tests, hearing aid fittings, and the devices themselves are completely excluded under traditional Medicare.
• Routine Vision Care: Regular eye exams for prescription glasses, as well as contact lenses and eyeglasses, are not covered (aside from standard lenses after cataract surgery).
• Long-Term Care: Ongoing custodial care—such as daily help with bathing, dressing, eating, or long-term nursing home stays—is not covered, as Medicare only pays for short-term skilled nursing rehabilitation.
• Care Outside the United States: Medical treatments and services received while traveling internationally are generally not covered.