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 MRI (magnetic resonance imaging) 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 considers reasonable. The scan itself must be ordered by your doctor and performed at a facility that accepts Medicare, or the coverage may not explore.

The key word is medically necessary. Medicare will not pay for an MRI done as a routine check-up, to screen for disease when you have no symptoms, or because you want one for reassurance. Your doctor has to document in your medical record why the scan is needed to diagnose or treat a specific condition — back pain, a suspected stroke, joint injury, or cancer follow-up, for example.

Key Takeaways

  • Medicare Part B covers 80 percent of MRI costs when your doctor orders it for a medical reason, and you pay 20 percent after your deductible.
  • The facility must be Medicare-approved; if it is not, you may owe the full cost even though your doctor ordered the scan.
  • Medicare will not pay for MRI scans done for screening, routine check-ups, or without a doctor's order, no matter your age or health status.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower than the standard 20 percent.
  • Your doctor's office can tell you before the scan whether Medicare is likely to cover it based on your condition and medical history.

When Medicare will and will not cover an MRI

Medicare covers MRI when it is the right tool to diagnose or monitor a condition your doctor is already treating. Common reasons include evaluating back or neck pain, checking for stroke or brain tumors, assessing joint injuries, staging cancer, or monitoring the heart. Your doctor decides whether an MRI is necessary — not you, and not the imaging center.

Medicare will not cover an MRI ordered for screening purposes, meaning scans done to look for disease in people with no symptoms. It also will not cover MRI done at your request without a medical reason, even if you are willing to pay out of pocket and then ask Medicare to reimburse you. Once Medicare denies a scan as not medically necessary, you are responsible for the full bill.

How much you will pay out of pocket

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. In 2024, the Part B deductible is $240 per year, but this amount changes annually. Once you meet the deductible, Medicare pays 80 percent and you pay 20 percent of the approved amount.

The approved amount is not always what the facility charges. If an imaging center bills $2,000 but Medicare's approved amount is $1,200, Medicare pays 80 percent of $1,200 ($960), and you pay 20 percent of $1,200 ($240). You do not owe the extra $800 — that is the facility's write-off. However, if the facility does not accept Medicare assignment, you may be billed for the difference. Always confirm before your scan that the facility accepts Medicare assignment.

If you have a Medigap policy (supplemental insurance), it may cover some or all of your 20 percent coinsurance. If you have a Medicare Advantage plan, your costs depend on your plan's rules — some charge a copay per scan instead of coinsurance, and some have different deductibles. Check your plan documents or call the plan before scheduling.

How to learn about your MRI will be covered

The best time to check is before you have the scan. Ask your doctor's office to contact Medicare or use a process called advance beneficiary notice (ABN) to find out whether Medicare will cover your specific MRI. Your doctor's office usually does this automatically when they order the scan.

If Medicare is likely to deny the scan, the imaging center will give you an ABN form to sign before the procedure. This form tells you that Medicare may not pay, and it explains what you will owe if they do not. You can choose to have the scan anyway and pay out of pocket, or you can decline.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) with your doctor's name, your condition, and the type of scan ordered. Medicare staff can tell you whether the scan is covered based on the information you provide, though your doctor's office usually handles this step.

What happens if Medicare denies your MRI

If Medicare denies your MRI as not medically necessary, you have the right to appeal. You can file an appeal within 120 days of the denial letter. The appeal process has several levels: first a review by Medicare, then by an independent contractor, then by an administrative law judge if needed.

During an appeal, you can submit additional medical records, test results, or a letter from your doctor explaining why the MRI was necessary for your care. Many denials are overturned on appeal when new information shows the scan was medically justified. Your doctor's office or a patient advocate can help you gather the documents you need.

If you cannot afford to wait for an appeal and need the scan urgently, you can pay out of pocket and then submit the bill to Medicare for reconsideration. Keep all receipts and the denial letter.

MRI at an outpatient hospital versus an imaging center

Medicare covers MRI at both hospital outpatient departments and independent imaging centers, as long as both are Medicare-approved. The main difference is cost to you. Hospital outpatient departments often charge more because they bill a facility fee in addition to the technical fee for the scan itself. An independent imaging center typically charges less.

Your doctor may have a preference based on the type of MRI needed or the equipment available. If your doctor orders the scan at a hospital, ask whether an independent center in your area could do the same scan for less. Medicare's approved amount is the same either way, but the facility's charge may differ, and that affects your out-of-pocket cost if the facility does not accept assignment.

Special situations: MRI for specific conditions

Medicare has specific rules for MRI in certain situations. For example, Medicare covers MRI of the brain for suspected stroke, dementia, or tumor, but not for routine headaches. It covers MRI of the spine for suspected herniated disc or spinal cord injury, but not for mild back pain without nerve symptoms. It covers cardiac MRI when ordered by a cardiologist for heart disease, but not as a routine screening test.

If you have been diagnosed with cancer, Medicare covers MRI for staging and monitoring, even if you have no symptoms. If you have had a stroke or transient ischemic attack (TIA), Medicare covers follow-up brain MRI. If you have a pacemaker or certain metal implants, you may not be able to have an MRI at all, and your doctor will order a different type of scan instead.

Frequently Asked Questions

Will Medicare pay for an MRI if my doctor thinks I might have a problem but I have no symptoms?

It depends on the condition. If your doctor has clinical reason to suspect a serious condition — for example, signs of stroke on examination, or a family history of early-onset dementia with cognitive changes — Medicare may cover the MRI. But if you straightforward want screening because you are worried, Medicare will not pay. Your doctor has to document the medical reason in your chart.

What if I have already paid for an MRI out of pocket? Can I ask Medicare to reimburse me?

You can submit the bill to Medicare for review, but Medicare will only reimburse if the scan was medically necessary according to their rules. If Medicare would have denied it beforehand, they will likely deny reimbursement too. Always check before paying out of pocket.

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

Medicare Advantage plans must cover the same services as Original Medicare, but they can charge different copays, coinsurance, or deductibles. Some plans cover MRI with a flat copay; others use coinsurance like Original Medicare. Check your plan's coverage details or call your plan before scheduling.

If the imaging center says my MRI is not covered, do I have to pay the full bill?

Not necessarily. If you signed an ABN form beforehand, you agreed to pay if Medicare denied it. If you did not sign an ABN and Medicare denies coverage, the facility cannot bill you the full amount — they must write off the difference between their charge and Medicare's approved amount. Ask the facility for a copy of the denial letter and your ABN form.

Can I get an MRI at a facility that does not accept Medicare?

Yes, but Medicare will not pay. You will owe the full cost. If the facility is Medicare-approved but does not accept assignment, Medicare will still pay 80 percent of the approved amount, but you may owe the difference between the approved amount and what the facility charges. Always ask whether a facility accepts Medicare before scheduling.