A person may need to have a brain scan to diagnose a brain illness or condition. This can either be done with a Magnetic Resonance Imaging, or MRI, scan or a Computer Tomography, or CT, scan.
If you may need one or more of these, a common question is “does Medicare cover brain scans?” In this article, we answer the question in clear, plain English. You will also find the average costs of CT and MRI scans and other helpful info.
Does Medicare Cover Brain Scans?
The short answer is yes; Medicare will cover the cost of brain 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 CT or MRI scans. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for brain scans. Parts A and B cover many medically necessary diagnostic tests which also include CT and MRI scans. Both tests are usually considered medically necessary tests as they are used to diagnose many types of medical conditions.
For Medicare to provide coverage for your brain scan, it is required that your:
- Healthcare provider ordered either a CT or an MRI scan and states why it is necessary in that order
- MRI scan has been prescribed by your healthcare provider for diagnostic reasons
- Medical records show that you need to undergo these test
- Healthcare provider participates in Medicare and the brain scan will take place in a Medicare-approved setting
Coverage for brain 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 brain scans.
On the other hand, coverage for brain 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 brain 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 Brain Scans
Medicare Advantage plans (Medicare Part C) also provide coverage for brain scans. Advantage plans must (by law) cover all the treatments, tests, etc. that Original Medicare. So if something is covered by Part A or B, it will be covered by Part C too. Part C plan will offer additional benefits as well that Original Medicare does not cover. These benefits will differ from plan to plan.
How Much Does A Brain Scan Cost?
An MRI scan for diagnosing brain conditions may range from $1,000 to $5,000. A CT scan generally costs from around $50 to $1,000.
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.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover nutrition counseling for obesity?