What Medicare Covers for CT Scans

Medicare covers CT scans, but only when your doctor orders them for a medical reason

Medicare Part B pays for CT scans that your doctor says you need to diagnose or treat a condition. The scan must be ordered by a doctor, performed at a facility Medicare approves, and documented as medically necessary in your medical record. You typically pay 20% of the approved amount after you meet your Part B deductible for the year. The remaining 80% is covered by Medicare.

What Medicare will not pay for: CT scans done for screening when you have no symptoms (like screening for lung cancer if you don't smoke and have no symptoms), scans ordered by someone who is not a doctor, or scans done at a facility that is not Medicare-approved. If your doctor orders a scan that Medicare later determines was not medically necessary, you may receive a bill.

Key Takeaways

Medicare Part B covers CT scans when a doctor orders them to diagnose or treat a medical condition you have.
You pay 20% of the Medicare-approved cost after meeting your annual Part B deductible; Medicare pays the other 80%.
The facility performing the scan must be Medicare-approved, which includes hospitals, imaging centers, and some doctor's offices.
Screening CT scans without symptoms are usually not covered, though there are exceptions for certain high-risk groups like current or former heavy smokers.
Ask your doctor before the scan whether Medicare will cover it and what your out-of-pocket cost will be.

When Medicare covers CT scans

Medicare Part B covers a CT scan when a doctor believes it is necessary to find out what is causing your symptoms or to monitor a condition you already have. Common reasons include chest pain, abdominal pain, headaches, suspected stroke, cancer follow-up, or injury evaluation. The doctor must document in your medical record why the scan is needed and what condition it is meant to evaluate.

There is one important exception: Medicare does cover low-dose CT screening for lung cancer in people who meet specific criteria. You must be between 50 and 77 years old, have a 20 pack-year smoking history (meaning you smoked one pack a day for 20 years, or two packs a day for 10 years), and either currently smoke or quit within the past 15 years. Your doctor must order the screening and it must be done at a Medicare-approved facility. This screening is covered once per year.

What you pay out of pocket

Your cost depends on whether you have met your Part B deductible for the year. The Part B deductible changes each year; you can find the current amount on Medicare.gov or by calling 1-800-MEDICARE. Once you have paid that deductible, Medicare covers 80% of the approved cost and you pay 20%.

The actual bill varies by location and facility. A CT scan of the abdomen might cost between $500 and $3,000 depending on where you live and which facility performs it. Medicare pays based on its own approved amount, which is usually lower than what a facility charges. If the facility is in-network with Medicare, they cannot charge you more than 20% of the approved amount. Always ask the facility what your estimated cost will be before the scan.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower. Medigap plans often cover the 20% coinsurance. Medicare Advantage plans have their own rules about CT scan coverage and cost-sharing, so check your plan documents or call your plan before scheduling.

Where you can get a CT scan covered by Medicare

Medicare covers CT scans performed at hospitals, imaging centers, and some doctor's offices — but only if the facility is Medicare-approved. Most major facilities are approved, but it is worth confirming before you go. You can search for approved facilities on the CMS (Centers for Medicare & Medicaid Services) website or ask your doctor's office whether the place they are referring you to accepts Medicare.

If your doctor refers you to a facility that is not Medicare-approved, Medicare will not pay for the scan. You would be responsible for the full cost. This is why it matters to ask your doctor whether the facility is Medicare-approved before you schedule.

How to make sure Medicare will cover your CT scan

Before you schedule a CT scan, have a conversation with your doctor. Ask whether Medicare will cover the scan and what your estimated out-of-pocket cost will be. Your doctor's office can often contact Medicare or check coverage rules ahead of time. Some doctor's offices have staff who specialize in checking coverage before procedures.

You can also call Medicare directly at 1-800-MEDICARE to ask whether a specific scan is covered. Have your Medicare number ready and be able to describe the reason your doctor wants the scan. Medicare staff can tell you whether the scan meets coverage rules and what your cost will be.

If your doctor orders a scan and Medicare later denies it as not medically necessary, you have the right to appeal. Your doctor's office can help with this. You should not have to pay if your doctor ordered the scan in good faith and documented the medical reason.

CT scans Medicare does not cover

Medicare does not cover CT scans done for screening in people without symptoms, with a few exceptions. For example, a CT scan to screen for colon cancer is not covered (colonoscopy is the covered screening test). A CT scan to screen for heart disease in someone with no symptoms is not covered. A CT scan of the spine to screen for arthritis in someone with no back pain is not covered.

Medicare also does not cover CT scans ordered by someone who is not a licensed doctor — for example, a scan ordered by a chiropractor or naturopath. The scan must be ordered by a medical doctor, doctor of osteopathy, or other licensed practitioner within Medicare's rules.

If you pay out of pocket for a scan that Medicare would not cover, you cannot later ask Medicare to reimburse you. This is another reason to confirm coverage before scheduling.

What to ask your doctor before a CT scan

Before you agree to a CT scan, ask your doctor these questions: Why do you think I need this scan? What condition are we looking for? Is there another test that might work instead? Will Medicare cover this scan? What will my out-of-pocket cost be? Where will the scan be done, and is that facility Medicare-approved?

Your doctor should be able to answer all of these. If they cannot tell you whether Medicare will cover it, ask them to find out before you schedule. It takes a few minutes and can save you hundreds of dollars.

Frequently Asked Questions

Do I need a referral from my primary care doctor to get a CT scan covered?

No. Medicare does not require a referral. Any licensed doctor can order a CT scan and Medicare will consider covering it if it is medically necessary. However, your primary care doctor may be a good starting point if you are unsure whether you need the scan.

Will Medicare cover a CT scan if I have symptoms but my doctor thinks it is probably not serious?

Yes, as long as your doctor documents that the scan is medically necessary to rule out a serious condition. The doctor does not have to be certain you have a problem — they just have to have a reasonable medical reason to order the test.

What happens if I get a CT scan and then find out Medicare will not pay for it?

If the facility is Medicare-approved and your doctor ordered it for a medical reason, Medicare should pay. If Medicare denies the claim, you have the right to appeal. Ask the facility to submit an appeal on your behalf. Do not pay the bill until the appeal is resolved.

Does Medicare cover CT scans with contrast dye?

Yes. If your doctor orders a CT scan with contrast dye (a special liquid that helps structures show up more clearly), Medicare covers it the same way as a regular CT scan. You pay the same 20% coinsurance. Tell your doctor if you have kidney problems or allergies, as contrast dye is not safe for everyone.

If I have a Medicare Advantage plan, does it cover CT scans the same way?

No. Medicare Advantage plans set their own coverage rules and costs. Some cover CT scans with no cost-sharing, some charge a copay, and some require prior approval from the plan before the scan. Check your plan documents or call your plan's customer service before scheduling.

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.