What Medicare Covers for MRI Scans

Medicare covers MRI scans, but only when your doctor orders one for a medical reason and uses a facility that accepts Medicare

Medicare Part B covers MRI (magnetic resonance imaging) scans as a diagnostic tool when a doctor believes the scan will help diagnose or monitor a condition. You pay 20% of the approved amount after you meet your Part B deductible for the year. The facility performing the scan must be enrolled in 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 just to check on your general health or because you want one. Your doctor has to document in your medical record why the scan is needed to evaluate a specific symptom or condition. If Medicare later reviews the claim and decides the scan was not medically necessary, you could be responsible for the full bill.

Key Takeaways

Medicare Part B covers MRI scans when ordered by your doctor for a medical reason, and you pay 20% of the approved cost after meeting your deductible.
The imaging center must be enrolled in Medicare; calling ahead to confirm saves you from unexpected bills at out-of-network facilities.
Your doctor must document medical necessity in your chart, or Medicare may deny the claim and leave you with the bill.
If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower than the standard 20%.
Prior authorization is sometimes required; ask your doctor's office whether Medicare needs approval before scheduling.

When Medicare will and will not cover an MRI

Medicare covers MRI scans to evaluate back pain, joint injuries, brain conditions, spinal cord problems, and soft tissue damage. Your doctor might order an MRI instead of an X-ray when they need to see muscle, ligament, or organ detail. The scan is also covered to monitor known conditions like tumors or multiple sclerosis.

Medicare will not cover an MRI ordered for screening purposes when you have no symptoms — for example, a brain MRI to check for disease in someone with no neurological complaints. The agency also does not cover MRI scans of the heart for most routine situations, though there are exceptions for specific cardiac conditions. If your doctor orders an MRI but does not document a medical reason in your chart, Medicare may deny the claim even if the scan was performed.

What you pay out of pocket

Your cost depends on whether you have original Medicare alone, a Medigap plan, or a Medicare Advantage plan. With original Medicare Part B, you pay 20% of the Medicare-approved amount after you have met your annual Part B deductible (which is $240 in 2024, though this amount changes yearly). If the imaging center charges more than Medicare's approved amount, you are responsible only for the 20% of the approved amount — the center cannot bill you for the difference.

If you have a Medigap plan, it typically covers some or all of your 20% coinsurance, depending on which plan you chose. Medicare Advantage plans vary widely; some cover MRI scans with a copay (often $100 to $300), while others require coinsurance. Check your plan documents or call your plan's member services line before scheduling to know your exact cost.

Prior authorization and scheduling

Some MRI scans require prior authorization from Medicare before they are performed. This means your doctor's office must contact Medicare (or a contractor working on Medicare's behalf) to confirm the scan is medically necessary before you go in for the procedure. If your doctor orders an MRI and does not obtain prior authorization when it is required, Medicare may deny the claim.

Ask your doctor's office whether prior authorization is needed before you schedule. The office staff usually handles this step, but it can take a few days. If you schedule without checking, you risk either having to reschedule or receiving a bill you did not expect. Some imaging centers also check this themselves when you call to book, so mentioning that you have Medicare can help them flag the requirement.

How to confirm the facility accepts Medicare

Before scheduling your MRI, confirm that the imaging center is enrolled in Medicare. You can search the Medicare provider directory at Medicare.gov by entering the facility name and your state. Look for the facility's Medicare enrollment status — it should say "Enrolled" or "Accepting Medicare."

If you call the imaging center directly, ask the scheduling staff: "Are you enrolled in Medicare?" A straightforward yes answer is what you want. If they say they are not enrolled or they are unsure, ask your doctor to refer you to a center that is. Out-of-network imaging centers can charge you much more, and Medicare will not help cover the difference.

What happens if Medicare denies your MRI claim

If Medicare denies your claim, the imaging center must send you a notice called an Explanation of Benefits (EOB) or a Medicare Summary Notice (MSN). This notice explains why Medicare denied it — usually because the scan was deemed not medically necessary or because prior authorization was not obtained.

You have the right to appeal. You can ask your doctor to provide additional documentation about why the scan was necessary, and your doctor's office can resubmit the claim with that information. If Medicare denies the appeal, you can request a formal review. The imaging center or your doctor's office can guide you through the appeal process, or you can contact Medicare directly at 1-800-MEDICARE.

MRI scans and Medicare Advantage plans

If you have a Medicare Advantage plan instead of original Medicare, the rules are similar but the costs may differ. Your plan must cover MRI scans that are medically necessary, just as original Medicare does. However, your copay or coinsurance amount depends on your specific plan and whether you use an in-network or out-of-network facility.

Some Medicare Advantage plans require prior authorization for MRI scans, while others do not. Check your plan's member handbook or call member services before scheduling. Using an in-network imaging center almost always costs you less than an out-of-network one, so ask your plan which facilities are in-network in your area.

Frequently Asked Questions

Do I need a referral from my doctor to get an MRI covered by Medicare?

You do not need a formal referral, but your doctor must order the MRI and document the medical reason in your chart. Medicare reviews the order to confirm it is medically necessary. If your doctor straightforward suggests you get an MRI without ordering it, Medicare will not cover it.

Will Medicare cover an MRI if I have symptoms but my doctor thinks it is not necessary?

No. Medicare covers the scan only if your doctor orders it and documents medical necessity. If your doctor does not think an MRI is needed, Medicare will not pay for one you obtain on your own. You would pay the full cost yourself.

What if the imaging center says they do not bill Medicare?

Some imaging centers do not enroll in Medicare and do not accept Medicare payment. If you use a non-enrolled facility, you will have to pay the full bill upfront, and Medicare will not reimburse you. Always confirm enrollment before scheduling.

Can I get an MRI scan just to check my health, and will Medicare cover it?

No. Medicare does not cover screening MRI scans in people without symptoms. The scan must be ordered to evaluate a specific medical problem or symptom your doctor is investigating.

How long does it take Medicare to approve an MRI?

Prior authorization usually takes three to five business days. Once approved, you can schedule the scan. After the scan is performed, Medicare processes the claim within two to four weeks. If there are questions about medical necessity, the review can take longer.

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.