Does Medicare Cover CT Scans?
Computed tomography (CT) scans are important diagnostic tools that give physicians detailed images from inside a person’s body. CT scans use rotating X-ray tubes to take images that are processed on computers through tomographic reconstruction algorithms which in turn produce cross-section images of the body.
Your physician might order a CT scan to assist in diagnosing bone damage, blood flow problems, stroke, cancer, internal injuries, heart disease, or heart abnormalities, or to find tumors or lesions within the abdomen.
If you’re enrolled in Medicare, your insurance should cover medically necessary diagnostic tests. Here’s a look at how your Medicare benefits cover CT scans.
Will Medicare help pay for CT scans?
Medicare covers medically necessary tests that are used to diagnose, prevent, or treat a medical condition. Because CT scans help physicians diagnose medical conditions like those mentioned above, they are considered medically necessary in most instances.
If you’re enrolled in Original Medicare Parts A and B, coverage for your CT scan depends on where you have it done:
Medicare Part A (hospital insurance)covers your CT scan if your physician orders one to be done while you’re admitted as an inpatient in a hospital, a skilled nursing care facility, or another type of inpatient facility. To be eligible for this coverage, the hospital or facility must accept Medicare assignment.
Medicare Part A covers the cost of your CT scans as well as your other inpatient charges, but you are responsible for paying the Part A deductible for the benefit period. If your inpatient care extends beyond 60 days, you also pay a daily coinsurance charge.
Medicare Part B (medical insurance)covers medically necessary CT scans that your health care provider, who accepts Medicare assignment, orders during outpatient care in Medicare-affiliated facilities such as:
- Physician’s offices
- Urgent care or health centers
- Outpatient clinics
- Outpatient labs or testing facilities
- Outpatient surgical centers
Medicare Part B pays 80 percent of the final approved cost for your CT scans. You pay the remaining 20 percent after meeting your annual Part B deductible.
How does a Medicare Advantage cover CT scans?
If you’re enrolled in a Medicare Advantage (Part C) plan, your provider must cover all benefits included in Original Medicare Parts A and B. If your CT scans are ordered by a physician because they are medically necessary, your provider must cover them. However, you may need to have them done at a medical facility that is approved by your provider.
Your Medicare Advantage plan should have a printed directory of approved providers within its network, but if you aren’t sure, check with your plan for details before making medical appointments.
Any coinsurance or copayment charges you have for your CT scans depend on what Medicare Advantage coverage you have. Because Medicare Advantage plans are offered by private insurance companies, costs and benefits may vary.
How much does a CT scan cost without Medicare coverage?
The cost of your CT scan depends on whether you have it done at an inpatient or outpatient facility. In general, outpatient centers charge much less than hospitals or other inpatient centers.
In the United States today, the national average cost of a CT scan is $3280, but they range between $300 and $6750. Based on national statistics, the average cost for a CT scan in an outpatient facility is $525, and $4750 at an inpatient facility.