How Much Does Medicare Pay for X-Rays?

X-rays are diagnostic tools providing internal views for diagnosis and treatment. Medicare covers X-rays for many Americans. While Medicare coverage for X-rays can be complex, understanding it helps beneficiaries manage healthcare costs.

Medicare Parts Covering X-Rays

Medicare’s coverage for X-rays depends on the specific part of the program a beneficiary is enrolled in and the setting where the service is provided. Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance), each covering X-rays under different circumstances. Medicare Advantage plans, offered by private insurers, provide an alternative way to receive Medicare benefits.

Medicare Part A

Medicare Part A covers X-rays performed during an inpatient hospital stay, a skilled nursing facility stay, or hospice care. For example, if a beneficiary is admitted as an inpatient for a fractured bone, X-rays taken during that hospital stay would fall under Part A coverage.

Medicare Part B

Medicare Part B covers medically necessary outpatient diagnostic X-rays. This includes X-rays performed in a doctor’s office, a freestanding radiology center, a hospital outpatient department, an emergency room, or an urgent care center. A healthcare professional must order the X-ray to diagnose or treat a medical condition for it to be covered. For example, a chest X-ray ordered for a persistent cough would typically be covered by Part B.

Medicare Advantage Plans

Medicare Advantage Plans (Part C) must cover at least the same services as Original Medicare Parts A and B, including medically necessary X-rays. These plans may have different rules regarding costs, provider networks, and administrative processes. Beneficiaries should consult their specific plan documents to understand their X-ray coverage details, including any network restrictions or cost-sharing arrangements.

Your Out-of-Pocket Costs for X-Rays

Understanding the financial obligations for X-rays under Medicare involves recognizing the deductibles and coinsurance associated with different parts of the program. These out-of-pocket costs represent the beneficiary’s share of the expense.

Part A Costs

For X-rays covered under Medicare Part A, the beneficiary is responsible for the Part A deductible per benefit period. In 2025, this deductible is $1,676. After the deductible is met, there is typically no coinsurance for the first 60 days of an inpatient stay; however, coinsurance applies for longer stays.

Part B Costs

For X-rays covered by Medicare Part B, beneficiaries must first meet their annual Part B deductible. In 2025, the Part B annual deductible is $257. After this deductible is satisfied, Medicare generally pays 80% of the Medicare-approved amount for the X-ray service. The beneficiary is then responsible for the remaining 20% coinsurance. For example, if a Part B-covered X-ray costs $500 and the deductible has been met, Medicare would pay $400, and the beneficiary would pay $100.

Medigap

Medicare Supplement Insurance, also known as Medigap, can help cover some or all of the out-of-pocket costs associated with Part A and Part B X-rays. These policies are offered by private companies and can assist with expenses like deductibles, coinsurance, and copayments that Original Medicare does not cover. While Medigap plans can reduce a beneficiary’s financial responsibility, they come with their own monthly premiums. Medigap plans work in conjunction with Original Medicare and cannot be used with Medicare Advantage plans.

Situations Affecting X-Ray Coverage and Cost

Beyond standard deductibles and coinsurance, several factors can influence whether an X-ray is covered by Medicare and what the ultimate cost to the beneficiary will be. These situations highlight the importance of understanding Medicare’s specific requirements.

Medical Necessity

For an X-ray to be covered, it must be medically necessary, meaning a qualified healthcare professional deems it required to diagnose or treat a medical condition. If an X-ray is not considered medically necessary by Medicare, or is ordered by a non-recognized provider (e.g., for routine dental care), it may not be covered, and the beneficiary could be responsible for the full cost.

Provider Acceptance of Assignment

The provider’s acceptance of Medicare assignment also impacts costs. “Accepting assignment” means the healthcare provider agrees to accept Medicare’s approved amount as full payment for a service. When a provider accepts assignment, Medicare pays its share, and the beneficiary is billed only for the deductible and coinsurance. If a provider does not accept assignment, they can charge up to 15% more than the Medicare-approved amount, known as an “excess charge,” which the beneficiary must pay in addition to their standard coinsurance.

Facility Type

The type of facility where an X-ray is performed can also lead to variations in cost. While Part B covers outpatient X-rays in various settings, hospital outpatient departments may sometimes charge facility fees. These fees can result in higher out-of-pocket expenses compared to X-rays performed in a physician’s office or an independent diagnostic testing facility.

Prior Authorization

Certain diagnostic imaging services, such as CT scans or MRIs, may require prior authorization from Medicare or a Medicare Advantage plan. It is important to confirm any prior authorization requirements, especially with Medicare Advantage plans, which may have specific rules. Failure to obtain necessary authorization could result in the service not being covered, leaving the beneficiary responsible for the entire charge.

Understanding Your Medicare X-Ray Bill

After receiving an X-ray, beneficiaries will receive documents from Medicare that summarize the services provided and how they were paid. These documents are important for tracking healthcare expenses and ensuring accuracy.

Medicare Summary Notice (MSN) or Explanation of Benefits (EOB)

The primary documents to review are the Explanation of Benefits (EOB) from a Medicare Advantage plan or the Medicare Summary Notice (MSN) from Original Medicare. These are not bills, but rather detailed statements showing what Medicare paid, the Medicare-approved amount, and the amount the beneficiary may owe. The MSN provides a summary of all services received during a three-month period, including X-rays.

Reviewing Documents

Beneficiaries should carefully review their MSN or EOB to ensure the services listed match the X-rays received and that the costs align with their understanding of deductibles and coinsurance. This review helps identify any potential billing errors or discrepancies. Checking for accurate dates of service, provider names, and the type of X-ray performed is a helpful practice.

Discrepancies and Appeals

If a discrepancy is found or if a service appears to have been incorrectly denied, beneficiaries have steps they can take. The first action is to contact the healthcare provider’s billing department for clarification or correction. If the issue is not resolved, beneficiaries can then contact Medicare directly for assistance or to initiate an appeal. The appeals process typically begins with a redetermination, where Medicare reviews its initial decision, and there are specific timeframes for filing these requests.