When Medicare Covers an MRI and When You Pay Out of Pocket

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

Medicare Part B pays for an MRI if your doctor believes it is medically necessary to diagnose or treat a condition you have. The scan itself is covered at 80 percent after you meet your Part B deductible for the year. You pay the remaining 20 percent, plus any amount above what Medicare considers the standard price in your area. The exact cost depends on where you have the scan done and whether your doctor is in the Medicare network.

Medicare does not cover MRIs ordered for screening purposes — meaning scans done when you have no symptoms and no diagnosis yet. It also does not cover MRIs you request for reassurance or a second opinion without a doctor's order. If your doctor orders the scan and Medicare denies it, you have the right to appeal, and your doctor can request a review before you are billed.

Key Takeaways

Medicare Part B covers MRI scans when a doctor orders them to diagnose or treat a specific medical condition you already have.
You pay 20 percent of the Medicare-approved amount after meeting your annual Part B deductible, which is $240 in 2024.
Medicare does not cover MRIs done for screening, prevention, or peace of mind without a medical diagnosis.
If Medicare denies your MRI, your doctor can request a review before you receive a bill, and you can file an appeal.
Medigap or Medicare Advantage plans may cover some or all of your 20 percent cost-sharing, depending on your specific plan.

What counts as medically necessary for Medicare

Medicare uses the term medically necessary to mean the scan is reasonable and necessary to diagnose or treat a condition your doctor has already identified. This includes MRIs for back pain with nerve damage, suspected tumors, stroke symptoms, joint injuries, or infections. It does not include routine screening for people without symptoms, even if you are at high risk for a disease.

Your doctor must document in your medical record why the MRI is needed and what condition it will help diagnose or treat. Medicare's contractors review this documentation before approving payment. If the documentation is weak or missing, Medicare may deny the claim. Your doctor's office can resubmit with more detail, or your doctor can request a peer-to-peer review — a phone call between your doctor and a Medicare medical reviewer to discuss whether the scan meets the standard.

How much you pay out of pocket

The amount you owe depends on three things: whether you have met your Part B deductible, what Medicare approves as the standard price, and where you have the scan done.

First, you must meet your Part B deductible — $240 in 2024 — before Medicare pays anything. Once you meet it, Medicare pays 80 percent of the approved amount, and you pay 20 percent. If the facility charges more than Medicare's approved amount, you may owe that difference as well. For example, if Medicare approves $1,000 for your MRI and the facility charges $1,200, you would owe $200 (the difference) plus 20 percent of $1,000 ($200), for a total of $400.

If your doctor's office is in-network with Medicare, they have agreed to accept Medicare's approved amount and cannot bill you for the difference. Out-of-network providers can charge more, and you are responsible for the overage. Before scheduling, ask the facility whether they accept Medicare assignment and what the Medicare-approved amount is for your specific scan.

MRI costs vary by location and facility type

A hospital-based MRI typically costs more than one at an independent imaging center, even for the same scan. Medicare's approved amount also varies by region — an MRI in a rural area may be approved at a different rate than one in a city. The facility's overhead, equipment, and staffing all affect the price.

If you are having an MRI at a hospital, ask whether the radiologist reading the scan is employed by the hospital or is an independent contractor. This can affect your bill — you may receive separate bills from the facility and the radiologist. Request an estimate from the facility before your appointment. Many will provide one if you give them your Medicare information and the specific scan your doctor ordered.

What to do if Medicare denies your MRI

If Medicare denies your claim, you will receive a notice called a Explanation of Benefits (EOB) in the mail. It will explain why Medicare denied it and what you can do next. Do not ignore this notice — you have rights, and your doctor can help you challenge the decision.

Your first step is to ask your doctor's office to request a peer-to-peer review. This is a conversation between your doctor and a Medicare medical reviewer about whether your scan was medically necessary. Many denials are overturned at this stage because your doctor can explain the clinical reasoning directly. If the peer-to-peer review does not change the decision, you can file a formal appeal. Your doctor's office can help you gather the medical records and documentation needed. The appeal process takes time — usually 30 to 60 days — but you should not be billed while your appeal is pending.

How Medigap and Medicare Advantage plans affect your cost

If you have a Medigap plan (supplemental insurance), it may cover some or all of your 20 percent cost-sharing. Most Medigap plans cover the 20 percent coinsurance after Medicare pays. Check your plan documents or call your Medigap insurer to confirm what they cover for imaging services.

If you have a Medicare Advantage plan, your coverage works differently. You may have a copay for the MRI instead of coinsurance, and the amount depends on your specific plan. Some Advantage plans require prior authorization — meaning your doctor must get approval from the plan before you have the scan. If you do not get prior authorization and the plan denies the claim, you may be responsible for the full cost. Always check with your Advantage plan before scheduling an MRI.

Questions to ask your doctor before scheduling an MRI

Before your appointment, ask your doctor these questions: Is this MRI medically necessary, or is it screening? Will Medicare likely cover it? Do you need to submit it for prior authorization? Should I have it done at a hospital or an imaging center? Can you provide the specific code for the scan so I can call ahead for a cost estimate?

If your doctor is unsure whether Medicare will cover it, ask them to check with their billing staff or to submit the order to Medicare for a coverage information before you schedule. This takes a few extra days but can save you from an unexpected bill. Some doctors' offices will do this routinely; others only if you ask.

Frequently Asked Questions

Does Medicare cover MRI for back pain?

Medicare covers an MRI for back pain if you have symptoms like nerve damage, numbness, or weakness that suggest a structural problem. It does not cover MRIs for mild back pain without nerve involvement, or for routine screening. Your doctor must document the specific symptoms and why imaging is needed to diagnose the cause.

What if I have a Medicare Advantage plan instead of Original Medicare?

Medicare Advantage plans must cover MRIs that Original Medicare would cover, but your out-of-pocket cost may be different — often a copay instead of 20 percent coinsurance. Many Advantage plans require prior authorization before the scan. Contact your plan before scheduling to confirm coverage and any approval steps needed.

Can I get an MRI without a doctor's order?

You can pay out of pocket for an MRI without a doctor's order, but Medicare will not cover it. If you later want Medicare to cover a related scan, you will need a doctor's order and a medical reason. Self-ordered scans do not count as medically necessary under Medicare rules.

Will I owe money if Medicare denies my MRI?

Not when ready. While your appeal is pending, you should not be billed. If your appeal is denied and you disagree, you can request a hearing before an administrative law judge. Do not pay a bill for a denied MRI until you have exhausted your appeal options or your doctor confirms the denial is final.

How do I find out what Medicare will approve before I schedule?

Call your doctor's billing office and ask them to submit your order to Medicare for a coverage information before you schedule. This takes a few days but gives you a clear answer. You can also call Medicare directly at 1-800-MEDICARE and provide your doctor's order and diagnosis, though the staff cannot make a final information — only your doctor's office can request that formally.

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.