Does Medicare Cover Diagnostic Scans and Tests?
Types of diagnostic tests that may be covered under Medicare Part B include CT scans, MRIs, electrocardiograms (EKGs), X-rays and other procedures that identify conditions by scanning your body. Your doctor or health care provider must order the scans, and you will be responsible for 20 percent of the cost after you pay the Part B deductible.
|Medicare Plan||Diagnostic Test Coverage|
|Part A (Inpatient)||Covered if medically necessary and ordered as part of an inpatient stay. Part A deductible applies.|
|Part B (Outpatient)||Covers 80% of costs for approved tests after you have reached your Part B deductible.|
|Part C (Medicare Advantage)||Covers everything covered by Medicare Part A and Part B. Select plans may provide additional benefits.|
|Part D (Prescription Drugs)||N/A|
|Supplemental Insurance||Can help cover out-of-pocket testing costs. Coverage varies by plan.|
What Are Diagnostic Non-Laboratory 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 Coverage of Diagnostic Scans and Tests
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 percent of the cost of diagnostic scans, leaving you to pay 20 percent 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.
- CT Scan:
- A scan used to identify various diseases or injuries. It is essentially a computerized X-ray that provides a clear image of the inside of your body.
- A scan that uses a magnet and radio waves to look inside your body and at your organs to diagnose a wide range of conditions. You lie inside a large tube that emits loud noises to receive this scan.
- Electrocardiogram (EKG):
- A quick and simple procedure that studies your heart to check if it is beating and working properly.
- Another imaging procedure to look inside your body that is often used to identify broken bones as well as conditions affecting your organs like pneumonia or lung cancer.
- PET Scan:
- An imaging procedure where a radioactive tracer is injected into your body before you are scanned. It’s most commonly used in cancer cases.
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.
Does Medicare Part A Cover Diagnostic Testing?
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.
Diagnostic Testing with Medicare Advantage and Medigap
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 percent coinsurance payment.
10 Cited Research Articles
- U.S. National Library of Medicine. (2021, May 4). Chest X-Ray. Retrieved from https://medlineplus.gov/ency/article/003804.htm
- U.S. National Library of Medicine. (2021, May 4). PET Scan. Retrieved from https://medlineplus.gov/ency/article/003827.htm
- U.S. National Library of Medicine. (2021, April 12). MRI Scans. Retrieved from https://medlineplus.gov/mriscans.html
- U.S. National Library of Medicine. (2020, December 10). Electrocardiogram. Retrieved from https://medlineplus.gov/lab-tests/electrocardiogram/
- U.S. Centers for Medicare & Medicaid Services. (2018, August). Are You a Hospital Inpatient or Outpatient? Retrieved from https://www.medicare.gov/sites/default/files/2018-09/11435-Are-You-an-Inpatient-or-Outpatient.pdf
- National Heart, Lung, and Blood Institute. (n.d.) Chest X-Ray. Retrieved from https://www.nhlbi.nih.gov/health/lung-tests
- National Institute of Biomedical Imaging and Bioengineering. (n.d.) Computed Tomography (CT). Retrieved from https://www.nibib.nih.gov/science-education/science-topics/computed-tomography-ct
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Diagnostic Non-Laboratory Tests. Retrieved from https://www.medicare.gov/coverage/diagnostic-non-laboratory-tests
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Advantage Plans. Retrieved from https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What’s Medicare Supplement Insurance (Medigap)? Retrieved from https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap