Does Medicare Pay for X-Rays? Coverage and Costs

Medicare, a federal health insurance program, provides healthcare coverage for millions of Americans, primarily those aged 65 or older and younger individuals with certain disabilities. The program helps manage the substantial costs associated with medical care, including diagnostic services like X-rays. Understanding how Medicare covers these services is important for beneficiaries to manage their healthcare expenses effectively and navigate the healthcare system.

Understanding X-ray Coverage Under Original Medicare

Original Medicare covers X-rays when medically necessary. Medical necessity means a healthcare provider has ordered the X-ray to diagnose or treat an illness, injury, or medical condition, and the service meets accepted medical standards. Coverage depends on whether the X-ray is performed during an inpatient hospital stay or on an outpatient basis.

Medicare Part A (Hospital Insurance) covers X-rays if a beneficiary is formally admitted to a hospital as an inpatient. This coverage extends to diagnostic services required as part of inpatient care or skilled nursing facility care.

For outpatient X-rays, Medicare Part B (Medical Insurance) provides coverage. This includes X-rays taken in a doctor’s office, outpatient clinic, urgent care center, or hospital outpatient department. Part B covers medically necessary diagnostic X-rays ordered by a physician or other healthcare provider.

Financial Responsibilities and Coverage Conditions

When X-rays are covered under Medicare Part B, beneficiaries typically have financial responsibilities that include a deductible and coinsurance. For 2025, the annual Medicare Part B deductible is $257. After this deductible has been met for the year, Medicare Part B generally pays 80% of the Medicare-approved amount for the X-ray, and the beneficiary is responsible for the remaining 20% coinsurance. This coinsurance applies to most outpatient services covered by Part B.

A fundamental condition for Medicare coverage of an X-ray is that it must be ordered by a licensed physician or another qualified healthcare provider. The X-ray must be for diagnostic or treatment purposes and align with established medical necessity criteria. If an X-ray is deemed not medically necessary by Medicare, or if it is ordered by a practitioner not authorized to do so (such as X-rays ordered by a chiropractor, unless for spinal subluxation, or for routine dental care), Medicare may not cover the cost.

Furthermore, to ensure coverage, the X-ray must be performed by a provider or facility that accepts Medicare assignment. This means the provider agrees to accept the Medicare-approved amount as full payment for the service. If an X-ray is performed without a physician’s order or by a non-Medicare-approved provider, the beneficiary may be fully responsible for the entire cost.

In situations where Medicare may not cover a service, the provider should issue an Advance Beneficiary Notice of Noncoverage (ABN) to the patient. This notice informs the patient that Medicare might not pay for the service and that the patient will be financially responsible if they choose to proceed.

Medicare Advantage and Supplemental Insurance Considerations

Beneficiaries have options beyond Original Medicare that can affect their X-ray coverage and costs, specifically through Medicare Advantage plans and Medicare Supplement Insurance (Medigap) policies. Medicare Advantage Plans, also known as Part C, are offered by private insurance companies approved by Medicare. These plans are required to cover at least all the services that Original Medicare Part A and Part B cover, including medically necessary X-rays.

While Medicare Advantage plans must provide the same level of coverage as Original Medicare, their cost-sharing structures, such as deductibles, copayments, and coinsurance, can differ. Many Medicare Advantage plans also operate with network restrictions, meaning beneficiaries may need to use providers and facilities within the plan’s network for services like X-rays to receive full coverage. It is important for individuals enrolled in these plans to review their specific plan documents for details on costs, network rules, and any prior authorization requirements for diagnostic imaging.

Medicare Supplement Insurance, or Medigap, policies work differently as they function alongside Original Medicare, not instead of it. Medigap policies help cover some of the out-of-pocket costs that Original Medicare does not pay, such as deductibles, copayments, and coinsurance for services like X-rays. For example, a Medigap policy could help pay the 20% coinsurance amount that remains after Medicare Part B has paid its portion for an outpatient X-ray. These policies require an additional monthly premium, but they can significantly reduce a beneficiary’s financial responsibility for covered services under Original Medicare.