What Medicare Covers for MRI Scans

Medicare covers MRI scans, but only when your doctor orders one for a medical reason — not for routine screening or peace of mind.

Medicare Part B pays for MRI scans at 80 percent of the approved amount after you meet your annual deductible. You pay the remaining 20 percent, plus any difference between what the facility charges and what Medicare allows. The scan must be ordered by your doctor as medically necessary, and the facility must be Medicare-enrolled.

The most common covered reasons are suspected stroke, spinal cord injury, brain tumors, multiple sclerosis, joint damage, and soft-tissue injuries. Your doctor decides whether an MRI is the right tool for your diagnosis — Medicare does not cover the scan if your doctor orders it without medical justification, even if you want one.

Key Takeaways

Medicare Part B covers 80 percent of MRI costs when your doctor orders the scan for a medical reason, and you pay 20 percent after your deductible.
The facility performing the MRI must be enrolled with Medicare, so ask before your appointment whether they accept Medicare.
Screening MRIs — scans done when you have no symptoms — are not covered by Original Medicare, though some Medicare Advantage plans may cover them.
Your doctor's order must show medical necessity; Medicare will deny payment if the scan was ordered without a documented medical reason.
If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower than the standard 20 percent.

How Medicare Determines Medical Necessity

Medicare uses Local Coverage Determinations (LCDs) to decide which MRI scans it will pay for in your region. These rules vary by state and by the body part being scanned. Your doctor's office usually knows whether Medicare will cover the scan before ordering it, because they check these rules regularly.

Your doctor must document in your medical record why the MRI is needed — for example, "patient reports numbness in left leg; rule out herniated disc" or "follow-up imaging for known brain lesion." If the documentation is vague or missing, Medicare may deny the claim even if the scan was performed. You can ask your doctor's office to show you the medical reason they are documenting before the scan happens.

Some scans are covered only under specific conditions. For example, Medicare covers an MRI of the brain for suspected stroke or tumor, but not for headaches alone. An MRI of the knee is covered for suspected ligament or meniscus tear, but not for general knee pain without imaging findings from an X-ray first.

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, you pay 20 percent of the Medicare-approved amount after your Part B deductible (which is $240 in 2024, though this amount changes yearly). If the facility charges more than Medicare allows, you may owe the difference as well.

A Medigap plan (supplemental insurance) typically covers the 20 percent coinsurance, so your out-of-pocket cost drops to zero or a small copay. A Medicare Advantage plan usually charges a copay per scan — often $100 to $300 — instead of the 20 percent coinsurance. Check your plan documents or call your plan's member services line to find out your exact cost before the scan.

If you have not yet met your Part B deductible for the year, you pay the full deductible amount first, then 20 percent of the approved amount. The deductible resets on January 1 each year.

Screening MRIs and When Medicare Does Not Cover

Medicare does not cover MRI scans done for screening — that is, scans ordered when you have no symptoms or medical reason for concern. This includes full-body MRI scans marketed as "wellness" or "preventive" imaging. If your doctor orders an MRI without documenting a medical reason, Medicare will deny the claim, and you will owe the full cost.

Some Medicare Advantage plans do cover screening MRIs as an added benefit, so check your plan documents if you are interested in preventive imaging. Original Medicare does not offer this coverage.

MRI scans for research purposes, experimental treatments, or imaging ordered by a provider who is not enrolled with Medicare are also not covered. Make sure the facility is Medicare-enrolled before your appointment.

How to Confirm Coverage Before Your MRI

Ask your doctor's office to check whether Medicare will cover your MRI before the scan is scheduled. Most offices have staff who verify coverage as part of their routine. They can tell you whether your specific diagnosis and the body part being scanned meet Medicare's rules for your state.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) and provide your doctor's reason for the scan. Medicare staff can tell you whether the scan is covered, though they may ask you to have your doctor's office call instead, since the office has your medical record.

If you have a Medigap or Medicare Advantage plan, contact your plan's member services line to find out your copay or coinsurance amount. This step takes a few minutes and prevents surprise bills later.

What Happens If Medicare Denies Your MRI

If Medicare denies your claim after the scan, you will receive a notice called an Explanation of Benefits (EOB) that explains why. Common reasons for denial are lack of medical necessity, the facility not being Medicare-enrolled, or incomplete documentation from your doctor.

You have the right to appeal a denial. Your first step is to ask your doctor's office to review the denial and provide additional medical documentation if needed. Many denials are reversed when the office submits more detail about your symptoms or test results that led to the MRI order.

If the denial stands after your doctor's office appeals, you can file a formal appeal with Medicare. The process takes time — usually several weeks — but you can continue to dispute the charge while the appeal is pending. Do not ignore a denial notice; responding within the important date (usually 120 days) protects your right to appeal.

MRI Costs at Different Facility Types

The cost of an MRI varies widely depending on where you have it done. Hospital outpatient departments typically charge more than independent imaging centers, even for the same scan. Medicare's approved amount is the same regardless of facility type, but the facility's actual charge may differ.

If you have Original Medicare and the facility charges more than Medicare allows, you are responsible for the difference — this is called balance billing. Medicare-enrolled facilities are supposed to accept Medicare's approved amount as payment in full, but it is worth confirming this when you schedule.

If cost is a concern, ask your doctor whether the scan can be done at an independent imaging center instead of a hospital. Independent centers often charge less, and your out-of-pocket cost may be lower. Your doctor can usually order the scan to be done at any Medicare-enrolled facility you choose.

Frequently Asked Questions

Will Medicare cover an MRI if my doctor orders it but I do not have symptoms?

No. Medicare covers MRI only when your doctor documents a medical reason — symptoms, test results, or a known condition that needs imaging. If the scan is ordered for screening or peace of mind without a medical reason, Medicare will deny it and you will owe the full cost.

What if my MRI facility is not enrolled with Medicare?

Medicare will not pay for the scan, and you will owe the entire bill. Always confirm the facility is Medicare-enrolled before your appointment. You can ask the facility directly, or your doctor's office can verify this when they place the order.

Do I have to pay my 20 percent coinsurance upfront, or can I pay after I get the bill?

You typically pay after you receive the bill. The facility bills Medicare first, Medicare pays its 80 percent share, and then the facility bills you for your 20 percent coinsurance. Some facilities may ask for payment at the time of the scan, so ask when you schedule.

Can I get an MRI at an out-of-state facility and have Medicare cover it?

Yes, as long as the facility is Medicare-enrolled. Medicare covers services at any enrolled facility in the United States. If you are traveling or live near a state border, you can use a facility in another state and Medicare will cover it the same way.

Does my Medicare Advantage plan cover MRI the same way as Original Medicare?

No. Medicare Advantage plans set their own rules for MRI coverage. Most require a copay instead of the 20 percent coinsurance, and some may cover screening MRIs that Original Medicare does not. Check your plan documents or call member services to understand your coverage.

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.