Does Medicare Cover MRI Of Shoulders?

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. MRI scans are often a diagnostic tool and can help in creating treatment plans for many different problems such as shoulder pain or injury.

For those who have shoulder problems and may need an MRI, you may be wondering “does Medicare cover MRI of shoulders?” In this article, we answer the question in clear, plain English. And you’ll find information on the average cost of an MRI scan and more.

Does Medicare Cover MRI Of Shoulders?

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 for Medicare to pay for your MRI scans. Here’s what you need to know.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for MRI scans for your shoulder condition. Parts A and B provide coverage for medically necessary diagnostic test. This includes 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, you must meet some requirements. 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 an 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 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, including 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 Shoulders

Medicare Advantage plans (Medicare Part C) also provide coverage for MRI scans for your shoulder-related conditions. In fact, they have to. Advantage plans must cover everything that Parts A & B cover. They will also offer coverage for things the Original Medicare does not cover. What each plan covers, and the fees you’ll pay for that coverage, vary from plan to plan.

How Much Does An MRI Scan Cost?

The costs of an MRI Scan ranges from $1,000 to $5,000. This varies depending on the exact type of MRI and the condition being monitored.

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.