Which MRI is covered by Medicare?

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Medicare covers medically necessary MRI (Magnetic Resonance Imaging) and MRA (Magnetic Resonance Angiography) scans when they are ordered by a doctor or qualified healthcare provider to diagnose or treat a specific medical condition.

Covered Types and Uses

According to the Official CMS National Coverage Determination, Medicare covers diagnostic scans for specific areas and conditions, including:

  • Head and Brain: Brain scans, brain stem, and central nervous system evaluations.
  • Spine: Disc disease and spinal column evaluations.
  • Joints and Soft Tissues: Knees, shoulders, and other joints for tears, injuries, or pain.
  • Abdomen and Pelvis: Solid organ parenchyma, retroperitoneal/mediastinal masses, and renal or aortoiliac arteries.
  • Blood Vessels (MRAs): Carotid vessels and lower extremity peripheral arteries.

How Coverage Works by Medicare Part

  • Medicare Part B (Medical Insurance): Covers 80% of the Medicare-approved amount for outpatient MRIs after you meet your yearly deductible. You pay the remaining 20% coinsurance (unless you have supplemental Medigap insurance).
  • Medicare Part A (Hospital Insurance): Covers 100% of the cost for an MRI if you get it while admitted as an inpatient in a hospital, after you pay the inpatient deductible.
  • Medicare Advantage (Part C): Private plans must cover everything Original Medicare covers, though your copays, coinsurance, and prior authorization rules may differ.

Requirements for Coverage

  • Medical Necessity: Your doctor must explicitly document and justify why the scan is required for your care. Medicare does not cover routine, preventive, or patient-requested MRIs without a clear clinical reason.
  • Approved Providers: Both the ordering doctor and the facility performing the scan must accept Medicare. Outpatient imaging facilities must also meet federal accreditation standards.
  • Prior Authorization: Some Medicare Advantage plans or specific types of advanced imaging may require pre-approval before your appointment.

How much will Medicare pay for a MRI?

Original Medicare pays for 80% of the Medicare-approved amount for a medically necessary MRI after you meet your annual deductible.

Coverage by Medicare Part

  • Medicare Part B (Outpatient): Covers 80% of the approved cost for outpatient scans. You pay the remaining 20% coinsurance plus any unmet Part B deductible.
  • Medicare Part A (Inpatient): Covers 100% of the cost if you get an MRI while admitted to a hospital as an inpatient, after you pay your Part A deductible.
  • Medicare Advantage (Part C): Private plans cover at least as much as Original Medicare, but your copays, network rules, and prior authorization requirements vary by plan.

Out-of-Pocket Costs

  • Deductible: You must meet your Part B deductible ($283 in 2026) before Medicare starts paying its share.
  • Average Patient Cost: After coverage kicks in, national average out-of-pocket costs typically range from about $9 at an ambulatory surgical center to $17 to $94 at a hospital outpatient department, depending on the exact facility and type of scan.
  • Requirements: Your doctor must accept Medicare and declare the MRI medically necessary for diagnosis.

Will Medicare pay for more than one MRI in a year?

Yes, Medicare will pay for more than one MRI in a year as long as each scan is medically necessary and ordered by a doctor.

Coverage Rules

  • No Yearly Limit: Medicare does not place a strict cap on the number of MRIs you can receive in a calendar year.
  • Medical Necessity: Your physician must order the scan to diagnose, monitor, or treat a specific injury, disease, or medical condition. Routine or elective screening MRIs are not covered.
  • Approved Providers: The doctor and the facility performing the MRI must accept Medicare and be appropriately accredited.

Costs You Might Pay

  • Part A (Inpatient): If you are admitted to a hospital or skilled nursing facility, Medicare Part A typically covers the full cost of the MRI after you meet your deductible.
  • Part B (Outpatient): If the MRI is done outside a hospital stay, Medicare Part B covers 80% of the Medicare-approved amount after you pay your annual deductible. You are responsible for the remaining 20% coinsurance, unless you have a supplemental policy like Medigap or a Medicare Advantage plan that lowers your out-of-pocket costs.

Does Medicare Part A or B cover MRI?

Medicare Part A and Part B cover MRI scans when they are ordered by a doctor and determined to be medically necessary for a diagnosis or treatment.

Coverage by Part

  • Medicare Part A (Hospital Insurance): Covers MRIs in full (after you meet your deductible) if you receive the scan as an admitted inpatient during a hospital or skilled nursing facility stay.
  • Medicare Part B (Medical Insurance): Covers 80% of the Medicare-approved amount for outpatient MRIs (after you meet your annual Part B deductible) as a diagnostic non-laboratory test. You are responsible for the remaining 20% coinsurance unless you have supplemental coverage like Medigap.

Requirements for Coverage

  • Medical necessity: Your physician must order the MRI to evaluate, diagnose, or treat a specific medical condition or injury.
  • Medicare acceptance: Both the doctor ordering the scan and the facility performing it must accept Medicare. You can review specific details and rules on the Medicare Diagnostic Tests Page.

What are the 5 things Medicare won't cover?

Original Medicare (Parts A and B) does not cover routine dental care, routine eye exams and eyeglasses, hearing aids and routine exams, long-term (custodial) care, and routine foot care.

Major Gaps in Original Medicare

  • Most Dental Care: Routine cleanings, fillings, tooth extractions, dental plates, and root canals are completely excluded from coverage.
  • Routine Vision Care: Regular eye exams, eyeglasses, and contact lenses are not covered, though treatment for specific diseases like cataracts or glaucoma is included.
  • Hearing Aids: Standard Medicare does not pay for hearing aids or routine fitting exams.
  • Long-Term Care: Assistance with daily personal needs (such as bathing, dressing, or eating) in a nursing home or at home is not covered if it is non-skilled custodial care.
  • Routine Foot Care: General podiatry services like trimming toenails or removing corns and calluses are excluded (with narrow exceptions for conditions like severe diabetic neuropathy).

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9 related questions found

What MRI is covered by Medicare?

Medicare covers specific diagnostic MRI scans listed on the Medicare Benefits Schedule (MBS) when they meet strict clinical criteria and are ordered by an eligible doctor.

General Rules for Medicare Coverage

  • Specific Conditions: Medicare does not cover all MRI scans. The scan must match exact clinical indicators (such as specific types of head trauma, knee injuries, or spine conditions) and sometimes age limits.
  • Referral Type: General Practitioners (GPs) can request Medicare-rebated MRIs for a limited range of conditions (such as certain knee, spine, or head scans). Specialists (like neurologists or orthopaedic surgeons) have broader rights to request Medicare-rebated MRIs for more complex conditions.
  • Hospital Status: MRIs performed while you are an inpatient in a public hospital are generally fully covered by Medicare.

Common Scanned Areas with Rebates

  • Brain & Head: Unexplained seizures or chronic headaches with suspected internal issues.
  • Spine: Cervical, thoracic, or lumbar spine trauma and specific nerve root compression (radiculopathy).
  • Joints: Knees (acute tears of the meniscus or cruciate ligament), shoulders, hips, and ankles under specific clinical criteria.

You can check if a specific location or machine is eligible via the Department of Health and Aged Services.

Do I need a referral for an MRI if I have Medicare?

You do not need a formal referral from a primary care doctor to get an MRI if you have Original Medicare, but you do need a written order from a Medicare-enrolled doctor showing the scan is medically necessary.

Original Medicare Requirements

  • No Referral Needed: You do not need a primary care physician (PCP) referral or permission to see a specialist or get an outpatient test.
  • Doctor's Order Required: A qualified doctor, nurse practitioner, or specialist must write an order or prescription for the MRI.
  • Medical Necessity: Medicare only pays if the scan is required to diagnose or treat a medical condition.
  • Medicare Facility: The testing facility must accept Medicare assignment.

Medicare Advantage (Part C) Differences

  • Plan Rules Vary: If you have a private Medicare Advantage plan, your specific rules might be different.
  • Prior Authorization: Many Advantage plans require prior authorization (approval before the scan happens).
  • Referrals and Networks: Some HMO-style Advantage plans require a formal referral or mandate that you use specific in-network imaging centers.

What is the cheapest way to get an MRI?

The cheapest way to get an MRI is to avoid hospital-affiliated imaging departments and instead use an independent, freestanding outpatient imaging center with upfront cash-pay or self-pay pricing.

Affordable Alternatives and Programs

  • Independent Imaging Centers: Choosing a standalone clinic instead of a major hospital system can reduce costs from thousands of dollars down to a range of $350 to $600 out-of-pocket.
  • Radiology Assist: This national non-profit program provides low-cost, all-inclusive diagnostic imaging for uninsured or underinsured patients, with MRI rates starting around $250 to $325.
  • MDsave: This online healthcare marketplace lets you prepurchase bundled vouchers for medical procedures at local partner clinics, often cutting out-of-pocket costs by half for high-deductible or uninsured patients (average MRI costs range from $600 to $800).

Cost-Saving Strategies

  • Ask for the Cash Price First: Call local independent clinics directly and ask for their self-pay or cash-discount rate before involving insurance, as high-deductible copays through insurance can sometimes cost more than paying cash upfront.
  • Skip Contrast if Optional: If your doctor says contrast dye is optional, skipping it can save an extra $100 to $300.
  • Confirm Inclusions: Always ask if the quoted price covers both the facility fee and the radiologist's reading fee so you do not receive a surprise second bill.

How to get a free MRI scan?

You can find heavily discounted diagnostic imaging or apply for assistance through programs like the RadiologyAssist network or the MSAA MRI Access Program if you have specific medical needs. Completely free clinical MRIs are rare, but several legitimate pathways exist to lower costs or receive scans at no charge.

Volunteer for Research Studies

  • Clinical trials: Academic medical centers and universities often need healthy volunteers or patients with specific conditions for brain or body imaging research.
  • Compensation: These studies are usually free and frequently pay participants for their time and travel.
  • Where to look: Search national databases like ClinicalTrials.gov or ResearchMatch using keywords like "MRI brain" or specific medical conditions.

Apply for Patient Assistance and Grants

  • Disease-specific charities: Organizations like the Multiple Sclerosis Association of America (MSAA) provide direct financial aid or coverage for specific diagnostic scans if you meet income limits.
  • Low-cost networks: Programs like RadiologyAssist coordinate heavily discounted self-pay and grant-funded rates starting around $300 at outpatient facilities for uninsured or underinsured patients.

Utilize Hospital Charity Care

  • Financial assistance policies: Non-profit and municipal hospitals are legally required to offer charity care or sliding-scale fees for low-income patients.
  • Application process: Ask the hospital's billing or financial department for a Financial Assistance Application before scheduling your procedure.

What is the average cost of a CT scan with Medicare?

The average out-of-pocket cost for an outpatient CT scan with Original Medicare is about $100 to $150, provided you have already met your annual deductible.

How Medicare Pays for a CT Scan

  • Total Approved Cost: The national average Medicare-approved amount for a standard outpatient CT scan (such as a CT of the head or spine) is roughly $508 total (combining doctor and facility fees).
  • Medicare Coverage: Original Medicare covers 80% of the Medicare-approved amount.
  • Your Share: You pay the remaining 20% coinsurance, plus any remaining portion of your Part B deductible ($283 in 2026) if you have not met it yet.

Factors That Change Your Cost

  • Type of Scan: Comprehensive scans (like an abdomen and pelvis scan with contrast) have higher total approved costs, often averaging over $1,000, meaning your 20% coinsurance will be higher.
  • Location: Having the scan done in a hospital outpatient department versus a freestanding independent imaging center can change the facility fee and add extra copayments.
  • Inpatient vs. Outpatient: If you are admitted to the hospital, the CT scan falls under Part A, which covers inpatient services under your hospital deductible rather than the Part B 20% coinsurance.
  • Supplemental Coverage: If you have a Medigap (Medicare Supplement) plan or a Medicare Advantage (Part C) plan, your actual out-of-pocket expenses may be significantly lower or fully covered.