Does Medicare Cover Diagnostic Scans and Tests?

Diagnostic non-laboratory tests can help diagnose conditions or rule out medical problems by allowing your doctor to get a look at the internal structure, bones and organs of your body through the use of different types of scans. Some of the most common types are CT scans, MRIs and X-rays.

Diagnostic scans can identify injuries, broken bones, cancer and many other diseases or conditions. They are different from diagnostic laboratory tests, which diagnose diseases through fluid and tissue samples taken from the body.

Medicare Part B covers diagnostic scans and tests if your doctor or health care provider orders them. The test must be used to either diagnose or rule out a possible cause of symptoms you’re experiencing. Diagnostic scans are separate from preventive services, which are used as part of routine checkups to screen for conditions that may have no symptoms.

Medicare will cover 80% of the cost of diagnostic scans, leaving you to pay 20% after your deductible is met. You will also have to pay a copayment if you are an outpatient in a hospital when you receive the test.

Diagnostic scans and tests may also be covered under Part B if you are receiving observation services, which are provided when a doctor observes you to determine whether you need to be admitted as an inpatient or discharged from the hospital.

Medicare Part A covers most inpatient services, and diagnostic scans are typically classified as outpatient procedures. However, the scans could be covered under Part A if you are an inpatient and the scans are deemed medically necessary.

Remember that you can stay overnight in a hospital and still be considered an outpatient. If any diagnostic scans are ordered while you are at the hospital, check with your doctor to determine if you are an inpatient or outpatient to estimate how Medicare will cover the scans.

Medicare Advantage plans must cover everything that Original Medicare does, so diagnostic tests should be covered if they are ordered by your doctor. But your specific plan could limit access since you must use doctors and medical facilities within your plan’s network. Be sure to check that these diagnostic tests are covered within your provider network.

Medicare supplement insurance, or Medigap, could also cover some of the costs associated with diagnostic testing. When combined with Original Medicare, supplement insurance can take care of some of your out-of-pocket costs, such as your 20% coinsurance payment.