What Medicare Covers for MRI Scans

Medicare covers MRI scans, but only when your doctor orders one for a medical reason and the scan meets Medicare's coverage rules

Medicare Part B covers MRI (magnetic resonance imaging) scans as a diagnostic tool when a doctor believes the scan will help diagnose or treat a condition. You pay 20 percent of the cost after you meet your Part B deductible for the year. The facility where you have the scan must be enrolled with Medicare — most hospitals and imaging centers are, but some private clinics are not.

The key word is "medical necessity." Medicare will not pay for an MRI ordered for screening purposes alone, or for a scan your doctor thinks might be useful but has not documented as necessary for your specific symptoms or diagnosis. The ordering physician must document why the MRI is needed, and the imaging center must submit that documentation to Medicare along with the claim.

Key Takeaways

Medicare Part B covers MRI scans when ordered by a doctor for a medical reason, and you pay 20 percent of the approved cost after meeting your deductible.
The facility performing the scan must be enrolled with Medicare; ask your doctor's office to confirm before scheduling.
Medicare may deny payment if the scan was ordered for screening only, without documented symptoms or a specific diagnosis being investigated.
Prior authorization is not required by Medicare for most MRI scans, but some Medicare Advantage plans require it — check your plan documents or call the number on your card.
If Medicare denies the claim, you have the right to request a review and can ask your doctor to provide additional medical records supporting the need for the scan.

How Much You Pay for an MRI Under Medicare Part B

Your out-of-pocket cost depends on whether you have met your Part B deductible ($240 in 2024, though this amount changes yearly). Once you meet the deductible, you pay 20 percent of Medicare's approved amount for the MRI. The approved amount varies by location and the type of MRI — a brain MRI costs differently than a spine MRI, for example.

The imaging center bills Medicare first. Medicare pays 80 percent of the approved amount to the center, and the center sends you a bill for your 20 percent share. If the center charges more than Medicare's approved amount, you are responsible only for 20 percent of the approved amount, not the difference — this is called "balance billing protection."

If you have not met your deductible, you pay the full approved amount until the deductible is satisfied, then 20 percent after that. Some imaging centers will estimate your cost before the scan if you ask; this estimate is based on what Medicare typically approves for that type of scan at that location.

When Medicare Will and Will Not Cover an MRI

Medicare covers MRI scans ordered to investigate symptoms, confirm a suspected diagnosis, or monitor a known condition. Examples include an MRI of the brain ordered because of headaches and dizziness, an MRI of the spine ordered for back pain that has not improved with other treatment, or an MRI of the knee ordered after an injury. The doctor's notes must document the reason for the scan.

Medicare does not cover MRI scans ordered purely for screening — for instance, a full-body MRI to look for disease in someone with no symptoms, or a brain MRI ordered only because of family history of a condition. Some private imaging centers offer these "wellness" scans; Medicare will not pay for them even if you are enrolled in Part B.

Medicare also does not cover MRI scans that duplicate recent imaging. If you had an X-ray or CT scan of the same area within a short time, Medicare may question whether a second scan is medically necessary. Your doctor can request a review if they believe the MRI is needed despite recent imaging.

Prior Authorization and Getting Approval Before Your Scan

Original Medicare (Part A and Part B) does not require prior authorization for most MRI scans. You can schedule the scan with your doctor's order, and Medicare will review the claim after the scan is done. However, if Medicare denies the claim later, you will have already paid your share and will need to request a review.

If you have a Medicare Advantage plan (Part C), the rules are different. Many Advantage plans require prior authorization before the scan — meaning the imaging center or your doctor's office must contact the plan and get approval before you have the MRI. Check your plan's website or call the number on your insurance card to find out whether prior authorization is required. If it is required and you skip that step, the plan may deny the claim even if the scan was medically necessary.

To avoid problems, ask your doctor's office to confirm that the imaging center is in-network (if you have an Advantage plan) and to check whether prior authorization is needed. This takes a few minutes and can prevent a denied claim.

What Happens If Medicare Denies Your MRI Claim

If Medicare denies payment for your MRI, the imaging center will send you a notice called an "Explanation of Benefits" (EOB) that explains the reason. Common reasons for denial include: the scan was not medically necessary, the ordering doctor did not document a clear reason for the scan, or the scan duplicated recent imaging.

You have the right to request a review of the denial. You can ask your doctor to submit additional medical records or a letter explaining why the MRI was necessary. The imaging center can also request a review on your behalf. The review process takes several weeks, and Medicare will issue a decision in writing.

If you disagree with the review decision, you can appeal further, but most people find it faster to work with their doctor to understand why the claim was denied and whether the scan was truly necessary for their condition.

MRI Costs If You Have Supplemental Insurance or Medicaid

If you have a Medigap (supplemental insurance) policy, it may cover some or all of your 20 percent coinsurance for the MRI. The amount depends on which Medigap plan you have. Plans C, D, G, and M cover the Part B coinsurance, meaning you would pay little or nothing out of pocket for the MRI. Plans A and B do not cover coinsurance. Check your Medigap policy documents or call your insurance company to confirm what your plan covers.

If you have both Medicare and Medicaid, Medicaid may cover costs that Medicare does not, including any remaining coinsurance. The rules vary by state. Contact your state Medicaid office to learn what your coverage includes.

If you have a Medicare Advantage plan, your coinsurance for an in-network MRI is usually lower than the standard 20 percent — often $0 to $150 depending on your plan. Check your plan documents or call the plan to find out your exact cost.

How to Schedule an MRI and Confirm Coverage

Ask your doctor to order the MRI and provide you with a written order or requisition. Give this order to the imaging center where you plan to have the scan. Before scheduling, call the center and confirm three things: that they accept Medicare, that they are in-network if you have a Medicare Advantage plan, and whether prior authorization is required.

If you have a Medicare Advantage plan, ask the imaging center to contact your plan for prior authorization. If you have original Medicare, you can proceed with scheduling. Ask the imaging center to estimate your out-of-pocket cost based on your deductible status — they can look this up using your Medicare number.

Bring your Medicare card and any other insurance cards (Medigap, Medicaid, or Advantage plan) to the appointment. After the scan, the imaging center will bill Medicare and any secondary insurance. You will receive bills from the center for any remaining balance.

Frequently Asked Questions

Does Medicare cover an MRI if I have not seen a doctor yet?

No. Medicare requires that a doctor order the MRI and document a medical reason for it. You must see a doctor first, describe your symptoms or condition, and have the doctor decide that an MRI is necessary. Walk-in imaging centers that offer MRI scans without a doctor's order cannot bill Medicare.

Will Medicare pay for an MRI of my whole body to check for disease?

No. Medicare does not cover screening MRI scans — scans ordered to look for disease in someone with no symptoms. If you want a full-body screening MRI, you would pay the full cost out of pocket, which typically ranges from $500 to $3,000 depending on the facility.

What if my doctor orders an MRI but Medicare says it is not necessary?

You can request a review and ask your doctor to provide more detailed medical records explaining why the MRI was needed. Your doctor can also request a review on your behalf. If Medicare continues to deny the claim, you can appeal further, though the process takes time.

Do I need prior authorization from Medicare before having an MRI?

Original Medicare does not require prior authorization. If you have a Medicare Advantage plan, many do require it — check your plan documents or call your plan to confirm. If prior authorization is required and you do not get it, your plan may deny the claim.

Can I use an imaging center that is not enrolled with Medicare?

You can, but Medicare will not pay. You would pay the full cost out of pocket. It is always better to use a Medicare-enrolled facility so that Medicare covers its share of the cost.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.