CT scans are diagnostic tests that Medicare covers if they are medically necessary and a healthcare professional orders them.
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 where the scan takes place.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Yes. Medicare generally considers a CT scan an outpatient non-laboratory test, which Part B covers, but 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 someone pays their out-of-pocket expenses.
After a person pays the Part B deductible, which is $240 in 2024, Medicare pays 80% of the eligible costs.
Medicare has a helpful tool for researching the cost of an outpatient procedure. This tool tells people 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 $18 in an ambulatory center or $27 in the hospital’s outpatient department.
Out-of-pocket costs
Most people with Medicare will have some out-of-pocket costs they will need to cover. They include:
Premiums and deductibles
Most people do not have a monthly premium for Part A. If they do, the maximum amount is $505 each month, with a deductible of $1,632 per benefit period.
Most individuals have a monthly premium for Part B, of which the standard 2024 amount is $174.70 with a deductible of $240.
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 in Medicare, they may have to pay more.
A CT scan involves 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 professional fits together to form a lifelike 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. A doctor will sometimes order a
When a healthcare professional uses contrast intravenously, which generally involves injecting iodine into a person’s bloodstream. This technique can help capture clearer images of internal systems, such as the circulatory system.
A doctor can also recommend taking an oral contrast, which can involve drinking a special solution. This helps take better pictures of the digestive system, such as the stomach and intestines.
When are CT scans used?
CT scans help find injuries or diseases inside the body without the need for surgery. Doctors use them to look for tumors, heart disease, and blood clots that may lead to stroke.
CT scans may also help healthcare professionals examine:
- head injuries
- suspected kidney stones
- suspected blood clots in the lungs
Due to CT scans producing ionizing radiation, the
Doctors can recommend other scans instead of a CT scan, which commonly include an MRI or an ultrasound.
MRI
MRI stands for
An MRI uses a large machine that produces clear pictures of small structures, including muscles, ligaments, tendons, and the spinal cord. Generally, people with implants containing iron cannot undergo these scans, as MRIs involve strong magnets.
Ultrasound
There are two types of
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.
Health experts generally consider these diagnostic tests safe, as they do not produce ionizing radiation.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
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 it 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.