CT scans are diagnostic tests covered by Medicare when medically necessary and ordered by a healthcare provider.
Original Medicare comprises Part A, covering inpatient hospital care, and Part B, covering outpatient medical care.
Coverage may come from parts A or B, depending on the setting of the scan.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Yes. Medicare generally considers a CT scan as an outpatient non-laboratory test, meaning the coverage comes from Part B, while corresponding out-of-pocket expenses typically apply.
If a doctor requires an individual to have a CT scan during an inpatient stay at the hospital, Part A will cover any eligible cost after a person pays their out-of-pocket expenses.
After a person pays the Part B deductible, which is $203 in 2021, Medicare pays 80% of the eligible costs.
Medicare has a helpful tool where a person can research the cost of an outpatient procedure. This tells them how much Medicare pays for the service.
A healthcare professional can request a CT scan for almost any part of the body, while the cost depends on the body part and scan type.
For example, a CT scan of the head or brain will cost a person $19 in an ambulatory center or $30 in the hospital’s outpatient department.
Most people with Medicare will have some costs that they will need to cover.
Premiums and deductibles
Most individuals have a monthly premium for Part B, of which the standard 2021 amount is $148.50, with a deductible of $203.
Coinsurance and copayments
Medicare Part B has a standard coinsurance of 20% of eligible costs.
While Part A does not have coinsurance, it does have an incremental copayment payable after a person has been in the hospital for 60 days or more.
Medicare Advantage costs
People with Medicare Advantage, also called Medicare Part C, may have different copayments and coinsurance, as private insurance companies administer these plans on behalf of Medicare.
Some Medicare Advantage plans have a $0 copayment, premium, and deductible. If a person chooses a CT scan at a facility that does not participate with Medicare, they may have to pay more.
A CT scan stands for computed tomography, a computerized X-ray that rotates around a person while they are inside a machine.
The computer creates several sliced images with detailed data that a healthcare provider fits together to form a life-like picture. Having a full picture can help a doctor identify and locate possible health conditions.
A CT scan accurately captures a dense structure, such as bone, but soft tissue is more difficult to see. To highlight soft tissue, a doctor will sometimes order a contrast CT scan.
When a healthcare provider uses contrast intravenously, which generally involves injecting iodine into a person’s bloodstream, it can help capture clearer images of internal systems, such as the circulatory system.
When a healthcare provider uses contrast orally, which can involve drinking a special solution, it helps take better pictures of the digestive system, such as the stomach and intestines.
When are they used?
CT scans may also help healthcare professionals examine:
Due to CT scans producing ionizing radiation, the American College of Radiology recommend discussing the need for a CT scan if a doctor orders one.
Doctors can recommend other scans instead of a CT scan, which commonly include an MRI or an ultrasound.
MRI stands for magnetic resonance imaging. It is a non-laboratory diagnostic image test that does not use ionizing radiation. Instead, it utilizes magnets and a radio frequency to develop images of the body.
An MRI uses a large machine that produces clear pictures of small structures, including muscles, ligaments, tendons, and the spinal cord. Since MRIs use strong magnets, people with implants containing iron are usually unable to undergo these scans.
There are two types of ultrasound: diagnostic and therapeutic.
Diagnostic ultrasounds are a noninvasive technique to capture an image inside the body. The method involves using a machine to produce sound waves at levels higher than a human can hear.
A doctor may order an ultrasound to see the heart, thyroid, breast, or blood vessels. However, ultrasounds do not take accurate pictures of bones or areas containing air.
Experts generally regard these diagnostic tests as safe as they do not produce ionizing radiation.
Medicare covers CT scans when medically necessary.
Medicare Part A will cover the costs if a person stays in the hospital, hospice, or skilled nursing facility as an inpatient.
Medicare Part B covers a scan when a person receives them as an outpatient.
There may be some out-of-pocket costs for a CT scan, and people may have to pay these in full if they visit a facility that does not accept Medicare.
Doctors can also choose to use an MRI test or diagnostic ultrasound as an alternative to a CT scan.