Medicare Part B covers medically necessary outpatient MRI scans ordered by a healthcare provider to evaluate or treat a medical problem. An order is important, but the service must also meet coverage and billing requirements. The site of care can change your costs.
Where the MRI takes place
| Setting | Original Medicare cost rules |
|---|---|
| Doctor’s office or independent testing facility | Generally 20% of the Medicare-approved amount after the Part B deductible. |
| Hospital outpatient department | A separate hospital copayment can apply and may exceed 20% of the approved amount. In most cases it cannot exceed the Part A inpatient deductible. |
| Formal inpatient hospital stay | Different Part A hospital rules apply; do not use an outpatient estimate for an inpatient stay. |
Ask whether there will be separate facility and professional bills. An MRI scheduled at a hospital is not automatically an inpatient service.
Check accreditation before an outpatient scan
For advanced imaging outside a hospital, including MRI, Medicare requires the imaging provider to be accredited. This applies to settings such as independent imaging centers, clinics and medical practices. Medicare states that if it does not pay because the provider lacks required accreditation, that provider cannot bill you for the test.
Confirm accreditation directly with the facility and verify that it accepts Medicare. Accreditation does not eliminate medical-necessity requirements or guarantee that every type of scan will be approved.
If you have Medicare Advantage
The plan must cover required Medicare benefits, but its network, prior authorization and patient costs can differ from Original Medicare. Check the exact imaging center and plan before scheduling. Ask the ordering office who will obtain any required approval and whether the requested location is included.
A practical scheduling checklist
- Confirm the ordering provider sent the correct order and supporting information.
- Verify the facility, service address and required accreditation.
- Ask about network participation and prior authorization if applicable.
- Request separate estimates for the facility and interpreting professional.
- Ask whom to contact if approval is delayed or the location changes.
- Keep the coverage decision and appeal instructions if a request is denied.
Your clinician decides whether an MRI is appropriate. This guide explains insurance questions and does not recommend a particular test.
Related coverage questions
- Medicare Part B: Medical Coverage, Costs and Enrollment
- Medicare Coverage Database: How to Read NCDs and LCDs
- How to Find and Verify a Medicare Provider