How Many X-Rays Will Medicare Cover?
Every year in the United States, approximately two billion X-rays are taken. Health care providers use these valuable diagnostic tools to examine bones, tissue, and air pockets inside the body, so they can evaluate medical conditions like:
- Bone fractures
- Bone infections
- Muscle sprains and strains
- Arthritis
- Osteoporosis
- Lung infections
- Certain types of cancer
- Heart conditions
- Blood vessel narrowing or blockages
- Digestive or abdominal issues
- Urinary tract issues
If you’re over 65, your health care provider might order X-rays for any of the reasons mentioned above, but also if you’re in pain or discomfort, or to monitor the progression of a treatment or a disease.
If you have Medicare insurance, you’re most likely eligible for coverage of any X-rays that your physician feels are medically necessary to diagnose or monitor a condition due to illness or injury
How many X-rays does Medicare cover?
Medicare doesn’t specifically state the number of X-rays it covers during a given time frame. However, each X-ray must be ordered by a physician or health care provider, and they must be medically necessary diagnostic X-rays to meet qualification requirements for Medicare coverage.
If you are enrolled in Original Medicare Parts A (hospital insurance) and B (medical insurance), your coverage for X-rays depends on where you have them done.
Original Medicare Part Acovers X-rays that are taken when you are an admitted inpatient in a hospital that accepts Medicare assignment if they’re ordered by a health care provider for medically necessary purposes. Through Medicare Part A you don’t pay for individual X-rays, but you must pay the Part A deductible for the current benefit period.
Original Medicare Part Bcovers its portion of the cost for medically necessary diagnostic X-rays that are taken at any outpatient setting that accepts Medicare assignment. Eligible outpatient centers can include surgical centers, physicians’ offices, a hospital emergency room, hospital outpatient clinics, urgent care centers, etc. Original Medicare Part B pays for 80 percent of the final approved cost for each X-ray. You pay the remaining 20 percent after meeting the Part B deductible for the year.
Medicare Advantage (Part C)plans are required to cover the same benefits as Original Medicare Parts A and B. This means that if your physician orders X-rays for medically necessary reasons, your plan must cover its share of the cost.
However, depending on the type of Part C coverage you have, you might need to use health care providers and medical facilities that are included in your plan’s network of providers to get coverage. Medicare Advantage plans also have the right to charge coinsurance or copayments that might be different from Original Medicare charges.
What types of X-rays aren’t covered by Medicare?
Medicare doesn’t cover X-rays that are ordered by a chiropractor even if they would be covered when ordered by a Medicare-associated physician. Original Medicare doesn’t cover X-rays taken for routine dental care, but a Medicare Part C plan with extra benefits might include these types of X-rays.
If you have a question about coverage for x-rays, talk to your doctor or contact your Medicare plan directly.
How much do X-rays cost without Medicare insurance coverage?
Without Medicare insurance, how much you pay for an X-ray depends on where you have it taken, how many views you need, and the type of X-ray. Right now, the average charge for X-rays in the United States ranges between $130 and $240 if you go to an urgent care facility. Costs typically run higher at hospital emergency rooms, but outpatient clinics charge less, generally between $45 and $250.