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 MRI scans if your doctor orders one to diagnose or monitor a condition. 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 allowable charge. The catch: Medicare will not pay if the MRI is ordered for routine screening, a second opinion without new symptoms, or any reason your doctor cannot document as medically necessary.

Where you have the scan done also matters. Medicare pays more readily when the MRI is performed at a hospital outpatient department than at an independent imaging center, though both are covered if the order is legitimate. If you go to an out-of-network facility, your out-of-pocket costs rise sharply.

Key Takeaways

Medicare Part B covers MRI scans when ordered by your doctor for diagnosis or monitoring of a medical condition, paying 80 percent after your deductible.
You are responsible for 20 percent coinsurance plus any charges above Medicare's allowable amount, which varies by location and facility type.
Medicare will not pay for MRI scans ordered for screening purposes, routine check-ups, or without documented medical necessity.
Hospital outpatient departments typically have lower out-of-pocket costs than independent imaging centers because of how Medicare reimburses each setting.
If your doctor orders an MRI at an out-of-network facility, ask the facility to verify your coverage before the scan to avoid surprise bills.

What counts as medically necessary for Medicare

Medicare uses the term medically necessary to mean the MRI is the right tool to diagnose, treat, or monitor a condition your doctor has already identified. Your doctor must document in your medical record why the MRI is needed — not just order it because you asked or because you are worried. Common reasons Medicare covers MRI include evaluating a new stroke symptom, checking for a tumor after an abnormal finding on another test, or monitoring a known spinal condition.

Screening MRIs — scans done on people with no symptoms or known condition — are almost never covered. If you have no back pain but want an MRI to see if anything is wrong, Medicare will not pay. If you had an MRI last year and your doctor wants another one this year without any change in your symptoms or new findings, Medicare may deny the second scan. Your doctor can appeal, but the burden is on them to show why the repeat scan is necessary.

The rule applies even if you have Medicare Advantage (Part C). Advantage plans must cover everything Original Medicare covers, but they can add their own rules about which imaging centers they use or how many scans you can have in a year. Check your plan's coverage details before scheduling.

How much you pay out of pocket

Your costs depend on whether you have met your Part B deductible and where the scan takes place. For 2024, the Part B deductible is $240 per year. Once you pay that amount toward covered services, Medicare begins paying its 80 percent share. You then pay 20 percent of the allowable charge for the MRI.

The allowable charge is not the same as the facility's bill. Medicare sets a maximum amount it will pay for an MRI in your area, based on local costs and the type of facility. If a facility bills $2,000 but Medicare's allowable charge is $1,200, Medicare pays 80 percent of $1,200 ($960), and you owe 20 percent of $1,200 ($240). The facility cannot bill you for the difference between $2,000 and $1,200 if they are in-network.

If the facility is out-of-network, you may owe the full difference. This is why calling ahead to confirm in-network status is critical. Ask the imaging center: "Is this facility in-network with Medicare?" and "What is my out-of-pocket cost for this MRI?" They should be able to give you a rough estimate based on your deductible status.

Hospital outpatient departments versus independent imaging centers

Medicare reimburses hospital outpatient departments and independent imaging centers differently, which affects your bill. Hospital outpatient departments typically receive higher reimbursement from Medicare, but they may also charge higher facility fees. Independent imaging centers often have lower overhead and may bill less, but Medicare's allowable charge for the same scan can be lower at an independent center than at a hospital.

The result is not always predictable: sometimes the hospital is cheaper for you, sometimes the independent center is. Before scheduling, ask both your doctor's office and the imaging facility what your estimated out-of-pocket cost will be. Provide your insurance information so they can look up your deductible status and calculate accurately.

If your doctor orders the MRI at a specific facility, ask why. Some doctors have contracts with certain centers or prefer their equipment. If cost is a concern, ask whether the scan could be done elsewhere without changing the medical outcome.

What to do before you schedule an MRI

Start by confirming with your doctor that the MRI is medically necessary and that they have documented the reason in your chart. Ask them which facility they recommend and whether it is in-network with Medicare. If your doctor does not know, call the imaging center directly and ask for the facility's Medicare provider number, then verify it on Medicare.gov or call 1-800-MEDICARE.

Contact the imaging center and provide your Medicare number. Ask them to verify your coverage and estimate your out-of-pocket cost. They will need to know your deductible status for the year. Request this information in writing if possible, so you have it before the scan.

If the facility is out-of-network, ask your doctor whether the scan could be done at an in-network location instead. If not, ask the out-of-network facility to submit a pre-authorization request to Medicare before your appointment. This does not may provide coverage, but it creates a record if there is a dispute later.

If Medicare denies your MRI

Medicare may deny payment if your doctor did not document medical necessity, if the scan was ordered for screening, or if the facility was out-of-network and did not meet certain conditions. When this happens, you will receive a notice called a Explanation of Benefits (EOB) in the mail. The EOB explains why the claim was denied and what you can do next.

If you believe the denial is wrong, your doctor can file an appeal on your behalf. They can submit additional medical records showing why the MRI was necessary. This process can take several weeks. In the meantime, you may receive a bill from the imaging facility. Do not ignore it, but do not pay it when ready either — contact the facility and let them know an appeal is pending.

If your doctor does not want to appeal, you have the right to request an independent review. Contact 1-800-MEDICARE and ask about the appeals process. Keep copies of all notices and medical records related to the scan.

Medigap and Medicare Advantage coverage for MRI costs

If you have a Medigap policy (supplemental insurance), it may cover some or all of your 20 percent coinsurance for the MRI, depending on which plan you have. Plans C, D, F, and G typically cover coinsurance. Check your policy documents or call your Medigap insurer to confirm what they cover for imaging services.

If you have Medicare Advantage, your plan covers the MRI the same way Original Medicare does — 80 percent after your deductible — but your deductible and coinsurance amounts may be different. Some Advantage plans have a separate deductible for imaging services. Review your plan's Summary of Benefits or call the plan directly before scheduling.

Neither Medigap nor Advantage changes whether Medicare considers the MRI medically necessary. If Original Medicare would deny it, your supplemental plan will not override that decision.

Frequently Asked Questions

Does Medicare cover MRI for back pain?

Medicare covers an MRI for back pain if your doctor orders it to diagnose the cause of your pain — for example, to check for a herniated disc or spinal stenosis. Medicare will not cover an MRI straightforward because you have back pain or as a routine screening. Your doctor must document that the MRI is needed to guide treatment.

Will Medicare pay for an MRI if I have not met my deductible?

No. You must pay your full Part B deductible ($240 in 2024) before Medicare begins paying its share. Once you meet the deductible, Medicare pays 80 percent and you pay 20 percent coinsurance. If the MRI is your first service of the year, you will owe the full deductible plus 20 percent of the allowable charge.

Can I get an MRI at an out-of-network facility and have Medicare pay?

Medicare will pay its share if the scan is medically necessary, but you may owe more out of pocket. Out-of-network facilities can bill you for the difference between their charge and Medicare's allowable amount. Always verify in-network status before scheduling, or ask your doctor to order the scan at an in-network location.

What if my doctor orders an MRI but Medicare says it is not medically necessary?

Your doctor can appeal Medicare's decision by submitting additional medical records and an explanation of why the MRI is necessary. The appeal process takes several weeks. Ask your doctor's office to handle this for you. If they decline, you can request an independent review by calling 1-800-MEDICARE.

Does Medicare cover MRI for dementia screening?

Medicare will not cover an MRI ordered solely for screening or early detection of dementia in someone with no symptoms. If you have symptoms of cognitive decline and your doctor orders an MRI to rule out a treatable cause (like a stroke or tumor), Medicare may cover it. The key is whether your doctor can document a medical reason beyond screening.

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.