Does Medicare Cover X-Rays and What Are the Costs?

Medicare is a federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease. Beneficiaries should understand how Medicare covers specific medical services, such as X-rays. This article explains X-ray coverage under different Medicare parts and outlines potential out-of-pocket costs.

X-ray Coverage Under Original Medicare Part B

Original Medicare Part B covers diagnostic X-rays when a treating doctor or other healthcare provider orders them. For coverage, an X-ray must be medically necessary, meaning it is needed to diagnose or treat a medical condition and meets accepted standards of medicine. Common examples of outpatient X-rays covered by Part B include chest X-rays for respiratory issues or bone X-rays for fractures.

Both the facility performing the X-ray and the interpreting radiologist must accept Medicare assignment. This means the provider agrees to accept the Medicare-approved amount as full payment, ensuring beneficiaries are not billed for more than the deductible and coinsurance. If a provider does not accept assignment, they may charge up to 15% more than the Medicare-approved amount, known as a “limiting charge,” and may require upfront payment.

Part B generally covers diagnostic X-rays, but with specific limitations. Routine dental X-rays are typically not covered unless required for a medical condition, such as a jaw issue or an oral infection before a kidney transplant. X-rays ordered by a chiropractor are generally not covered unless for manual manipulation of the spine to treat subluxation.

X-ray Coverage Under Original Medicare Part A

Original Medicare Part A covers X-rays when they are part of a covered inpatient hospital stay. This includes X-rays ordered as part of an inpatient treatment plan following formal hospital admission. Part A also covers X-rays received during a skilled nursing facility stay or as part of hospice care.

X-rays covered by Part A must occur within an inpatient setting. For instance, if a patient is admitted to a hospital, any X-rays performed during that admission, such as those to monitor progress, would fall under Part A. These X-ray services, along with other hospital services, are bundled into the overall inpatient hospital benefit.

X-ray Coverage Through Medicare Advantage Plans

Medicare Advantage Plans are offered by private insurance companies approved by Medicare. They must provide at least the same coverage as Original Medicare, meaning medically necessary X-rays are covered. These plans can also offer additional benefits not covered by Original Medicare, such as routine dental, vision, or hearing care, which may include routine dental X-rays.

Medicare Advantage plans operate with specific rules that differ from Original Medicare. Beneficiaries might need to use in-network providers, obtain referrals for specialists, or get prior authorization for certain services, including some X-rays. Review your plan’s documents or contact your provider to understand any network restrictions or authorization requirements for X-ray services.

Your Out-of-Pocket Costs for X-rays

Even with Medicare coverage, beneficiaries typically have out-of-pocket costs for X-rays. For Original Medicare Part B, after meeting the annual Part B deductible ($257 in 2025), you generally pay 20% of the Medicare-approved amount for the X-ray. This 20% is known as coinsurance. If the X-ray is performed in a hospital outpatient setting, a separate facility copayment might also apply.

For X-rays covered under Original Medicare Part A, the costs are integrated into the overall inpatient hospital expenses. In 2025, the Part A deductible is $1,676 per benefit period. After meeting this deductible, beneficiaries pay $0 for the first 60 days of an inpatient hospital stay. Beyond 60 days, daily coinsurance amounts apply, specifically $419 per day for days 61-90 and $838 per day for lifetime reserve days.

Medicare Advantage plans have varying cost-sharing structures, which can include different copayments, coinsurance, and deductibles for X-rays and other services. While some plans may offer a $0 copay for certain X-rays, others might have specific copayments for diagnostic radiological services. These plans also have an annual out-of-pocket maximum, which for 2025 cannot exceed $9,350 for in-network services or $14,000 for combined in-network and out-of-network services.

Steps to Ensure X-ray Coverage

To help ensure X-ray coverage, it is important to confirm that your doctor deems the X-ray medically necessary for your condition. Medicare only covers services that are proper and needed for diagnosis or treatment, not those primarily for convenience. Discuss the purpose of the X-ray with your provider to understand why it is being ordered.

For Original Medicare, always ask if the healthcare provider and the facility accept Medicare assignment. Providers who accept assignment agree to Medicare’s approved amount as full payment, which can help limit your out-of-pocket expenses. If you have a Medicare Advantage plan, verify that both your doctor and the facility are within your plan’s network to avoid higher costs. It is also advisable to inquire about any potential out-of-pocket costs, such as copayments or coinsurance, before receiving the service. For Medicare Advantage plans, confirm whether prior authorization is required for the X-ray, as this is a common requirement that, if missed, could lead to denial of coverage.