Medicare CT Scan Coverage in 2025-2025: Costs, Plans & What to Expect

Medicare provides coverage for medically necessary CT scans, but the specifics depend on the type of Medicare plan you have and where the scan is performed. Understanding how Part A, Part B, Part C (Medicare Advantage), and Medigap plans handle CT scan coverage can help you manage your healthcare expenses effectively.

Part A: Inpatient CT Scan Coverage

Part A, Medicare's hospital insurance, covers CT scans conducted during inpatient stays at hospitals, skilled nursing facilities, or other inpatient settings. Any CT scan ordered by your doctor during hospitalization falls under this coverage.

In 2024, the Part A deductible is $1,632 per benefit period, increasing to $1,676 in 2025. This deductible applies to your CT scan costs during your hospital stay. After meeting the deductible, Part A covers all inpatient tests and procedures without coinsurance for the first 60 days.

Part B: Outpatient CT Scan Coverage

Part B covers outpatient medical services, including CT scans performed at doctor's offices, urgent care centers, outpatient clinics, labs, and surgical centers that accept Medicare. Coverage applies as long as the facility participates in Medicare and the scan is ordered by a physician.

The Part B deductible is $240 in 2024 and rises to $257 in 2025. Once this deductible is met, Medicare pays 80% of the approved cost for your CT scan, leaving you responsible for the remaining 20%. Use the Medicare provider locator tool to find participating facilities near you.

Part C (Medicare Advantage): Network-Based CT Scan Coverage

Medicare Advantage (Part C) plans include coverage for CT scans but often require you to use network providers. Costs can be significantly higher if you go out-of-network, and some plans may not cover out-of-network services even if the facility accepts Medicare.

Deductibles, copayments, and coinsurance vary by plan. Contact your Medicare Advantage provider beforehand to get an accurate estimate of your CT scan costs.

Medigap: Supplemental Coverage for CT Scan Expenses

Medigap plans help cover out-of-pocket costs associated with Medicare, including deductibles and coinsurance for both Part A and Part B. Depending on your Medigap plan, you may have coverage for:

• Part A deductible
• Part B deductible
• Part A coinsurance and copayments
• Part B coinsurance and copayments

Although Medigap requires a monthly premium in addition to your Part B premium, it can significantly reduce your financial burden when you need services like CT scans.

Summary

If you undergo a CT scan during an inpatient hospital stay, Part A covers it after your deductible. For outpatient CT scans, Part B provides coverage with an 80/20 cost-sharing after the deductible. Medicare Advantage plans (Part C) cover CT scans but often within network restrictions and varying costs. Medigap plans offer supplemental coverage to lower your out-of-pocket expenses.

If Medicare denies coverage for your CT scan and you believe it should be covered, you have the right to file an appeal. This process allows you to provide additional information to demonstrate the medical necessity of the scan.

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