Does Medicare Cover An MRI Of The Brain?

Magnetic Resonance Imaging, or MRI, is a procedure that uses radio waves and magnetic fields to create an image of your bones and internal organs, including your brain. MRI scans can be used as a diagnostic tool and can help in creating treatment plans for many different medical conditions such as Alzheimer’s disease.

If your doctor tells you to get an MRI, you may be wondering “does Medicare cover an MRI of the brain?” In this article, we answer that question in clear, plain English. You will also find the average costs of MRI scans and other helpful info.

Does Medicare Cover an MRI Of the Brain?

The short answer is yes; Medicare will cover the cost of MRI scans. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your MRI scans. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for MRI scans for medical conditions that affect the brain. Parts A and B provide coverage for any medically necessary diagnostic tests, including MRI scans. MRI scans are usually considered medically necessary tests as they are used to diagnose many types of medical conditions.

For Medicare to provide coverage for your MRI scan, there are some requirements that you will have to meet. Those requirements consist of:

Your healthcare provider writes an order which states why you need to undergo an MRI scan
Your MRI scan has been prescribed by your healthcare provider for diagnostic reasons
The medical facility where you will undergo a MRI scan is Medicare-approved
Your healthcare provider participates in Medicare

Coverage for MRI scans is provided by Medicare Part A if it is part of your inpatient stay. Medicare Part A provides coverage for the treatment and care that you receive while staying in an inpatient facility. Medicare Part A will cover all the costs of your inpatient stay and services for the first 60 days which also includes your MRI scans.

On the other hand, coverage for MRI scans is provided by Medicare Part B if it takes place in an outpatient setting. However, for Medicare Part B to provide coverage for your outpatient MRI scan, the medical facility where you will receive the service must be Medicare-approved.

Medicare Part B will cover 80 percent of the costs of your MRI scan. You will pay for the remaining 20 percent.

Part C Coverage for MRI Of Brain

Medicare Advantage plans (Medicare Part C) also provide coverage for MRI scans for brain-related medical conditions. These plans have to (by law) cover all the things Original Medicare covers. But they will also cover additional health and medical related services as well. What each plan will cover and how much the plan (and the extra services it offers) costs will vary from plan to plan.

How Much Does An MRI Scan Cost?

A head MRI scan, which scans images of the brain as well as the nerve tissue that surrounds it, may cost $1,000 to $5,000. This depends on the reason for the MRI and where it takes place.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.