Does Medicare Part A Cover CT Scans?

Medicare is a federal health insurance program designed to assist individuals aged 65 or older, as well as some younger people with specific disabilities or permanent kidney failure. Many beneficiaries often wonder about the extent of coverage for diagnostic tests like CT scans. Understanding how Medicare addresses these imaging procedures is important for managing healthcare needs and costs.

Understanding Medicare Part A’s Scope

Medicare Part A, commonly referred to as hospital insurance, primarily covers inpatient services. This includes care received during a formal hospital admission. Part A also extends to skilled nursing facility care following a qualifying hospital stay, hospice care, and some home health services. For instance, a CT scan might be performed while an individual is formally admitted as an inpatient to a hospital.

In such cases, the CT scan’s cost is generally included as an integral component of the overall inpatient care received. It is important to recognize that Medicare Part A is not the primary source of coverage for diagnostic tests performed on an outpatient basis. Its focus remains on services provided during inpatient admissions or qualifying post-hospital care.

How Medicare Part B Covers CT Scans

Medicare Part B, also known as medical insurance, serves as the primary coverage for medically necessary outpatient diagnostic tests, including CT scans. For a CT scan to be covered under Part B, it must be ordered by a doctor or other healthcare provider and determined medically necessary for diagnosing or treating a medical condition, aligning with accepted medical practice. Part B covers a range of services such as physician services, outpatient hospital services, durable medical equipment, and various other medical services.

CT scans are typically covered under Part B in various outpatient scenarios, such as diagnostic workups performed in a doctor’s office, an outpatient clinic, or during an emergency room visit if the patient is not formally admitted as an inpatient. Medicare maintains specific guidelines for medical necessity, requiring proper documentation and a valid diagnosis code from the ordering physician to secure coverage.

Financial Responsibilities for CT Scans

Beneficiaries under Medicare Part B incur out-of-pocket costs for covered services, including CT scans. Before Medicare begins to pay its share, individuals must first meet the annual Medicare Part B deductible. For 2025, this deductible is $257. Once the deductible is satisfied, Medicare typically pays 80% of the Medicare-approved amount for most Part B services.

The remaining 20% is the beneficiary’s coinsurance responsibility, applying to the CT scan cost and any associated professional fees from the radiologist. If the CT scan is performed in a hospital outpatient department, beneficiaries may also be responsible for a copayment to the hospital facility. Medicare Supplement Insurance (Medigap) policies or Medicare Advantage plans can help cover some of these out-of-pocket expenses, such as deductibles and coinsurance.