Does Medicare Cover X-Rays?
X-rays have been used to investigate medical conditions and aid in the diagnosis of healthcare concerns since the early 1900s. In the late 1800s in Germany, Wilhelm Roentgen discovered the effects of current being passed through a cathode-ray tube. Today, having x-rays taken is a common type of test used in doctor’s offices as well as hospitals. An x-ray exam is a quick and painless way for healthcare professionals to view bones and some soft tissue without the need for invasive procedures.
Are x-rays harmful?
One misconception is that x-rays are harmful. While it’s true that exposure to x-rays can be harmful, the amount of radiation a person would need to accept in order to experience ill effects is many times that of a normal x-ray exam. Even if you need to have multiple x-rays taken periodically, there is generally no harm from these exams. As a precaution and to avoid contaminating x-ray image results, doctors may shield certain areas of the body using a vest or other body coverings to block x-rays from reaching unnecessary parts of the body.
Does Medicare cover x-rays?
Original Medicare provides coverage for x-rays in several different ways. Many people have x-rays taken in a clinical setting like a doctor’s office or a lab. These images may also be taken at a hospital if the hospital is the closest facility with access to x-ray equipment in your area.
In all of the above scenarios, x-ray exams are considered outpatient procedures. As such, they are covered through Medicare Part B. Part B provides coverage for a range of outpatient procedures, including doctor visits and surgery, and it also supplies benefits for durable medical equipment. Original Medicare benefits will cover 80% of the total cost of outpatient items, leaving the remaining 20% to be picked up by Medicare recipients.
Coverage for x-rays in a hospital
Another common setting for x-ray imaging is during admittance to a hospital. Treatment you receive while admitted to a hospital or skilled nursing facility is considered inpatient in nature and is covered by Medicare benefits through Part A. Medicare Part A is usually available premium-free to Medicare recipients over the age of 65. Receiving inpatient benefits is time-limited, but virtually all treatment during your stay is covered by Part A unless a doctor or specialist is brought in from outside of the hospital’s staff to administer treatment.
Medicare Part A provides inpatient coverage for 60 days per benefit period at 100%. This means that all treatment, including room and board, during your admittance is covered fully for 60 days. These days do not have to be consecutive. If you require additional treatment in an inpatient setting beyond 60 days, Medicare coverage will extend benefits for an additional 30 days, but you will pay a daily rate. This rate is determined by Medicare each year, but it is less than the full amount you would pay without Medicare coverage.
After 90 days, continued inpatient treatment is available if you utilize lifetime reserve days. All Medicare recipients receive 60 lifetime reserve days that can be used over the course of a lifetime. If you utilize lifetime reserve days, you will pay a per-day fee that is more than the discounted rate applied to days 60 through 90, but your costs will still be less than the full out-of-pocket cost of care.