Does Medicare Cover X-Rays?
X-rays are a common type of scan used to diagnose broken bones, infections and other conditions. Medicare will cover an X-ray if it is considered diagnostic and medically necessary. Your status as an inpatient or outpatient will determine which part of your Medicare coverage will help pay for the scan.
What Part of Medicare Covers X-Rays?
Original Medicare will not cover an X-ray unless it is clearly needed to diagnose a condition or assess an injury. For example, you must be experiencing some form of symptoms or at least minor trauma to receive coverage under Medicare. Scans that are exploratory or not a medical necessity will not be covered.
Most X-rays are performed as an outpatient procedure, which falls under Medicare Part B. But if you need an X-ray while you are an inpatient in the hospital, Medicare Part A should help cover the cost as part of inpatient care.
Even if your plan covers the Medicare-approved cost for services, you may be responsible for your deductible, coinsurance or a copayment depending on whether you undergo the X-ray as an inpatient or an outpatient.
It’s important to note that just because you are staying in a hospital, even overnight, it does not always mean you are an inpatient. You may still be considered an outpatient under observation status. If a doctor recommends an X-ray while you are in the hospital, be sure to find out your status as a patient to know what costs to expect.
- Outpatient hospital department
- Inpatient hospital stay
- Skilled nursing facility
- Other location or imaging facility
Additional coverage may be available through a Medicare Advantage plan, also known as Medicare Part C. These plans cover everything that is included in Original Medicare as well as additional benefits, so there could be more options available for X-ray coverage.
Medicare will cover other diagnostic scans and tests that are similar to X-rays. These include CT scans, MRIs and PET scans, which can be used to diagnose a wide range of conditions.
The additional diagnostic scans and tests are covered in the same way as X-rays. Check with your doctor or health care provider about which type of scan you need, so you can estimate your out-of-pocket costs.
When Is an X-Ray Necessary?
X-rays are most often used to diagnose broken bones or injuries, but they have many other uses. X-rays work by using radiation to generate an image of the internal structures of your body, including your organs.
Doctors can use the images to diagnose cardiac, pulmonary and inflammatory diseases as well as other internal conditions. They can also identify cancers, such as how mammograms are used to search for breast cancer.
When you undergo an X-ray, a technician will place a machine over the part of your body that needs to be scanned. You may be given a lead vest or apron for protection.
Risks associated with X-rays are minor. According to the U.S. National Library of Medicine, you get the same amount of radiation from a typical chest X-ray as you receive naturally from the environment over a 10-day span.
The benefits of receiving an X-ray to diagnose a serious condition far outweigh the risks. According to Harvard Medical School, the threat is miniscule unless you received high doses of radiation as a child to treat cancer.
8 Cited Research Articles
- U.S. National Library of Medicine. (2021, April 12). X-Rays. Retrieved from https://medlineplus.gov/xrays.html
- U.S. Food & Drug Administration. (2020, September 28). Medical X-Ray Imaging. Retrieved from https://www.fda.gov/radiation-emitting-products/medical-imaging/medical-x-ray-imaging
- Harvard Medical School. (2020, January 29). Radiation risk from medical imaging. Retrieved from https://www.health.harvard.edu/cancer/radiation-risk-from-medical-imaging
- National Institute of Biomedical Imaging and Bioengineering. (n.d.). X-Rays. Retrieved from https://www.nibib.nih.gov/science-education/science-topics/x-rays
- 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.). Local Coverage Determination (LCD): Chest X-Ray Policy (L37547). Retrieved from https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=37547&ContrId=364
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What Part A Covers. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-a-covers
- U.S. Centers for Medicare & Medicaid Services. (n.d.). X-Rays. Retrieved from https://www.medicare.gov/coverage/x-rays