- CT scans are a common diagnostic test to assess many types of injuries and illnesses.
- Medicare covers diagnostic tests under Part B.
- You can also get coverage for diagnostic tests under Part A while you’re admitted in the hospital.
- Medicare Advantage plans cover CT scans as well, but costs will depend on your specific plan.
You might need a computed tomography (CT) scan if your doctor wants to see inside your body to make a diagnosis.
CT scans can let doctors get a closer look at your organs. They can also show:
Medicare covers CT scans — but the amount of coverage will depend on where you have the scan and which part of Medicare is covering it.
Medicare will cover any medically necessary diagnostic tests you need. This includes CT scans.
Medicare considers a service medically necessary if it is used to diagnose, prevent, or treat a medical condition. CT scans are used to diagnose a number of conditions and are generally considered medically necessary.
Your exact coverage will depend on where you have the test and which Medicare part is covering it.
Coverage in a hospital (Part A)
If you need a CT scan during an inpatient hospital stay, Medicare Part A will cover you.
Medicare Part A is hospital insurance. It covers the care you receive during an inpatient stay at:
- a hospital
- a skilled nursing facility
- another inpatient facility
This includes any tests your doctor orders during your stay. So, if you receive a CT scan in the hospital, Part A will cover it.
Coverage in an outpatient center (Part B)
Outpatient CT scans are covered under Medicare Part B (medical insurance). Part B covers outpatient care, including CT scans, at multiple types of healthcare facilities, such as:
- doctor’s offices
- urgent care centers
- health centers
- outpatient clinics
- outpatient labs and testing facilities
- surgical centers
Part B will cover your CT scan no matter which outpatient setting you have it in. You’ll have coverage as long as the facility participates in Medicare and the CT scan is ordered by a doctor.
You can use the tool on the Medicare website to check for facilities and providers that participate in Medicare in your local area.
Medicare Advantage coverage
Together, Medicare parts A and B make up what’s known as original Medicare. A Medicare Advantage (Part C) plan combines both parts of original Medicare — and often many extra benefits, too — into a single plan.
Medicare Advantage plans are offered by private companies but are overseen by Medicare and need to follow certain rules.
One rule is that Medicare Advantage plans are required to cover everything that original Medicare does. That means all Medicare Advantages plans will cover CT scans.
However, many Medicare Advantage plans have networks. You might pay much higher costs for going out of your plan’s network. In some cases, you won’t have any out-of-network coverage at all, even if the facility participates in Medicare.
Your plan should have a directory of providers that are part of its network. You can always check with your plan to find in-network providers as well.
Outpatient diagnostic tests, like CT scans, are covered under Medicare Part B as long as they’re medically necessary and ordered by a Medicare-approved provider.
You can use the coverage search tool on the Medicare website if you’re not sure whether a test or procedure is covered.
Your CT scan should be covered in most cases. There are a couple of ways to ensure you receive coverage, including:
- Your doctor writes an order stating why you need the CT scan.
- Your medical records show you need the CT scan.
- Your doctor participates in Medicare.
- The facility where you get your CT scan participates in Medicare.
If Medicare doesn’t cover your CT scan and you think it should, you can file an appeal. An appeal will give you several chances to explain why the CT scan was medically necessary and see whether Medicare will cover it.
The cost for your CT scan will depend on several factors, including where you have the scan and which part of Medicare is covering it.
Here are a few examples of what a CT might cost in different situations:
- When you have a CT scan in the hospital. In this situation, the cost of a CT scan will go toward your Part A deductible. In 2021, the Part A deducible is $1,484 for each benefit period. Once you’ve met this deductible, Part A will cover all tests and procedures during your stay, with no coinsurance costs during the first 60 days of hospitalization.
- When you have an outpatient CT scan. After you meet your Part B deductible — $203 in 2021 — Medicare will pay 80 percent of the Medicare-approved cost of your CT scan. You’ll be responsible for the other 20 percent.
- If you have a Medicare Advantage plan. Your Medicare Advantage plan will have its own costs. The deductible and any copayment or coinsurance amount will depend on your plan. Contact your plan ahead of time, if possible, to get an estimate of how much this test will cost.
The exact cost of your CT scan will also depend on individual factors like your location and the exact type of CT scan you need.
For example, according to the Healthcare Blue Book, the average price for a chest CT scan in Detroit, Michigan ranges from $215 to more than $1,500. Compare that with the average cost of a CT scan of your abdomen and pelvis in Los Angeles, California, which ranges from $453 to more than $3,000.
You won’t pay these full amounts when you use Medicare. Instead, the portion you pay will be based on your share of the Medicare-approved amount. This amount tends to be much lower than standard prices.
For example, the Medicare procedure pricing tool shows that the average price of a chest CT scan in an outpatient surgical center is $115. So, if you have an outpatient CT scan under Part B coverage, you’d pay $22 and Medicare would pay $92, as long as you’ve already met your yearly deductible.
If you’re using Part B, you can use the pricing tool to get an idea of what your costs will be. You’ll need to know the exact type of CT scan your doctor has ordered.
And keep in mind that the tool will only show you averages. Your actual costs might be higher or lower.
Can I use a Medigap plan to cover my CT costs?
One way to lower your out-of-pocket costs for diagnostic tests is with a Medigap plan.
Medigap is supplemental insurance that you can buy to cover your out-of-pocket costs from Medicare. Depending on your Medigap plan, you may be able to get coverage for your:
- Part A deductible
- Part B deductible
- Part A copays and coinsurance
- Part B copays and coinsurance
That means that any costs of your CT scan that would typically fall to you would instead be covered by Medigap.
Medigap plans do have a monthly premium on top of your Medicare Part B premium. So, while you’ll pay more each month, the costs will be taken care of when you need a service like a CT scan.
A CT scan is a test that allows doctors to see inside your body. The scan takes X-ray images from multiple angles Each X-ray image shows a flat single section, or slice.
When the slices are put together using computer technology, a CT scan can allow your doctor to have a three-dimensional view.
CT scans are used to diagnose many different conditions, such as:
- internal injuries
- bone fractures
- heart disease
- lung disease
- liver abnormalities
- blood clots
You might also have a CT scan to check on how well a treatment is working.
For example, a CT scan might be used to see if radiation therapy is shrinking a tumor. In this case, you might need several CT scans over the course of your treatment. Medicare will cover all of them as long as they’re deemed medically necessary.
What can I expect when I go in for a CT scan?
CT scans are generally painless and can be completed in just a few minutes. CT machines use more radiation than standard X-rays but not enough to cause harm.
In some cases, you might need to take contrast material into your body before your scan. Contrast material is a liquid that helps highlight the part of your body doctors are trying to see.
Depending on the area of your body being scanned, you’ll either need to:
- swallow contrast material
- receive in an injection of contrast material
- receive an enema of contrast material
You won’t need any preparation in cases when contrast material isn’t needed. Once you’re ready for your CT scan, you’ll normally put on a hospital gown and remove personal items like:
A technician will help get you set up and explain the procedure to you.
During the scan, you’ll lie on a narrow table that’ll slide you through a large tunnel that acts as a scanner. It will take a series of X-rays as you slowly move through it. You might hear buzzing or clicking sounds, but you won’t feel anything.
It’s important to lie still during your CT scan to get the clearest images possible. The table you’re on might have pillows or other supports to help you remain still.
The technician will be in the next room monitoring your scan. They might talk to you using an intercom to remind you to hold still or ask you to hold your breath.
Once your CT scan is over, you can leave the outpatient center. You’ll be able to do your normal activities, and your doctor’s office will contact you with the results.
- CT scans are used to diagnose many kinds of medical conditions.
- Medicare Part A will cover your CT scan if you have it during an inpatient hospital stay.
- Medicare Part B will cover your CT scan when you have it as an outpatient.
- A Medicare Advantage plan will also cover a CT scan, but you’ll typically need to stay within your plan’s network.