Does Medicare Cover X-rays?
X-rays generate images of bones and other structures inside your body using electromagnetic waves. They’re popular in a range of medical specialties, and almost everyone has had or knows someone who has had an x-ray at one point or another. Depending on your circumstances, Medicare coverage can help pay for the costs associated with this diagnostic procedure.
Medicare will help cover the cost of diagnostic x-rays as long as they find them to be medically necessary. Medically necessary is any standard health care supply or services that get used to treat or diagnose any illness, disease, injury, or condition. If your primary care physician puts in orders for an x-ray to help treat or diagnose a health issue, this will fall into the standard medical practice category, and Medicare will come in to cover most of the service cost.
How or why does Medicare coverage work for x-Rays?
You should note that your Medicare insurance coverage will vary depending on why you need the x-ray and where you get it. This will directly impact which amount of the final bill you end up paying out of your pocket.
Part A coverage
Medicare Part A may cover your x-ray, but it’ll only pay for it if you’re admitted into the hospital as an inpatient when you have it. You may be uncertain whether you’re admitted into an inpatient or as an observation. Even if you stay overnight in the hospital, you could be admitted as an outpatient under observation. You should ask your doctor directly if they admitted you as an inpatient and how it impacts your Medicare insurance.
Part A will cover any services or tests that you need during an inpatient hospital stay. However, if you stay in the hospital for observation instead of an inpatient, Medicare Part B may come in and pay for your x-ray instead.
Part B coverage
Part B is the part of your coverage that typically pays for all of your medically necessary testing, including diagnostic imaging. Medicare covers the cost of your x-ray at most outpatient centers or if you get it as an outpatient service in a hospital. There are a few places where you can get an x-ray in the hospital and have Part B pay for it, and they include:
- Emergency room
- Inpatient hospital that has an outpatient radiology center
- Outpatient surgery center
- Physician’s office
- Urgent care center
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Part C coverage
If you have Medicare Part C or a Medicare Advantage plan, you’ll get the same coverage that you’d get with Original Medicare for your x-rays. However, most of these plans could have additional coverage, and this could change the total costs that you’d pay if you had Original Medicare. A Medicare Advantage plan could also set coverage limits that you wouldn’t have under Part A and Part B. For example, you may only be able to go to certain healthcare facilities or doctors that are in your plan’s network to get your x-rays.
General x-ray costs
How much your x-ray cost depends on the x-ray you have, how many films you need, and the setting where you get your x-ray. Generally speaking, most average around $200 before insurance. Out of this $200, Medicare will pay 80% of it. So, your costs are usually around $40.00 for most x-rays. You can always ask your doctor about the costs before you get an x-ray if you want a concrete cost.
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