Does Medicare Cover X-Rays? Explaining Your Coverage

X-rays are a common diagnostic tool, utilizing electromagnetic radiation to create images of internal body structures. These images help healthcare providers diagnose and monitor a variety of medical conditions, from bone fractures and infections to lung issues and heart conditions. Medicare generally provides coverage for X-rays when they are considered medically necessary. The specific details of this coverage, however, depend on the type of Medicare plan an individual has.

X-ray Coverage Under Medicare Part B

Medicare Part B, which serves as medical insurance, primarily covers X-rays performed in an outpatient setting. This includes X-rays taken in a doctor’s office, an independent testing facility, an urgent care center, or a hospital outpatient department. For coverage to apply, the X-ray must be ordered by a physician or other qualified healthcare provider to diagnose or treat a specific medical condition.

Common examples of X-rays covered under Medicare Part B include those for suspected broken bones, pneumonia, or to investigate joint issues. It also covers diagnostic X-rays used to assess injuries or help identify the cause of an illness. However, Medicare Part B does not cover all X-rays, such as those ordered by a chiropractor unless for manual spinal manipulation, or routine dental X-rays. The facility where the X-ray is performed must accept Medicare assignment for coverage to apply.

X-ray Coverage Under Medicare Part A

Medicare Part A, known as hospital insurance, covers X-rays when they are an integral part of a covered inpatient stay in a hospital. For instance, if an individual is admitted to the hospital for a severe injury, any X-rays performed during that inpatient stay to diagnose or monitor the injury would fall under Part A coverage.

Coverage under Part A also extends to X-rays received in a skilled nursing facility (SNF) if they are part of a covered inpatient SNF stay. It is important to note that Part A coverage is contingent on the patient’s status as an inpatient, not merely being under observation in a hospital. An X-ray performed during an observation stay would typically be covered under Part B.

How Medicare Advantage Plans Cover X-rays

Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans are required to provide at least the same benefits as Original Medicare, which includes coverage for medically necessary X-rays.

While the scope of coverage is similar, Medicare Advantage plans often have their own specific rules and cost structures. This can include network restrictions, requiring beneficiaries to use healthcare providers and facilities within the plan’s network to receive the highest level of coverage. Some plans may also require prior authorization for certain diagnostic services, including X-rays. Beneficiaries should review their specific plan’s details, including the Summary of Benefits, to understand any unique requirements or limitations.

Understanding Your Costs for X-rays

For those with Original Medicare Part B, after meeting the annual Part B deductible, which is $257 in 2025, beneficiaries typically pay 20% of the Medicare-approved amount for the X-ray. If the X-ray is performed in a hospital outpatient setting, a separate facility copayment may also apply.

Under Medicare Part A, X-rays performed during a covered inpatient hospital stay are generally included in the Part A deductible. In 2025, the Part A deductible is $1,676 per benefit period. A benefit period begins when an individual is admitted as an inpatient and ends after 60 consecutive days without inpatient hospital or skilled nursing facility care. Therefore, multiple benefit periods, each with a deductible, can occur within a single year.

For Medicare Advantage plan enrollees, costs for X-rays vary significantly by plan. These plans may have different deductibles, copayments, or coinsurance amounts for X-rays compared to Original Medicare. Many Medicare Advantage plans also include a maximum out-of-pocket limit, which caps the total amount a beneficiary pays for covered services in a year. Medicare Supplement Insurance (Medigap) plans can help cover some of Original Medicare’s out-of-pocket costs for X-rays, such as the Part B coinsurance and deductibles, but these plans have their own monthly premiums.