What to Know About Medicare and CT Scans
Article at a glance
CT scans are a common diagnostic test to detect many types of injuries or illnesses.
Medicare covers CT scans under Medicare Part B. However, what exactly Medicare pays will vary based on one’s specific health plan,
Medicare Part A will cover CT scans during hospital admission.
A CT scan is a diagnostic exam that can help healthcare providers find underlying medical conditions, including tumors and heart diseases, among other conditions. Before getting this evaluation, a Medicare beneficiary may want to check if their insurance covers the cost and any potential out-of-pocket costs associated with this computer imaging technique.
In most cases, Original Medicare will cover the majority of costs associated with receiving a CT scan. As well, Medigap policies or having a Medicare Advantage plan may help cut costs even more. That said, overall CT scan costs will vary based on the individual’s specific health care plan(s).
This article will explain everything Medicare beneficiaries need to know about how CT scans work under the federal Medicare program, including average costs, how to prepare for the scan, and more.
What Is A CT Scan?
A CT scan, also known as a CAT scan, is an imaging technique that uses computers and rotating X‑ray machines in order to create cross-sectional images of various internal body parts. CT stands for “computed tomography” or “computerized tomography”.
Why Are CT Scans Ordered?
A doctor orders this type of scan for suspected illness or injury. These scans can detect health issues in various parts of the body and helps doctors analyze the risk level, provide an accurate diagnosis, and suggest appropriate treatments, which may include medicine, surgery, or other recommendations.
Parts of the Body CT Scans Read
CT scans can detect injuries or illnesses in various parts of the body such as:
- Head
- Shoulders
- Spine
- Heart, including signs of heart disease and issues in blood vessels
- Abdomen
- Knees
- Chest
- Lungs
- Mouth
Does Medicare Cover CT Scans?
CT scans are considered to be one of several diagnostic non-laboratory tests covered by Medicare. These non-laboratory tests are covered under Medicare Part B, medical insurance. This includes MRI scans, EKGs, PET scans, and other diagnostic tests done in a doctor’s office or another outpatient setting such as an independent testing facility.
Criteria for CT Scan Coverage
That said, some criteria must be met in order for Medicare to cover a non-laboratory diagnostic test. Some such criteria include:
- A healthcare provider who accepts Medicare has ordered the test
- The test is performed at a Medicare-approved hospital or facility
- Medical records indicate the test is medically necessary
- Patient meets the criteria for lung cancer CT scan screening
As well, Medicare Part A, Medicare’s hospital insurance, may also provide CT scan coverage if the test is ordered during inpatient hospitalization.
CT Scans for Lung Cancer
Certain beneficiaries may be eligible for annual CT scanning of their lungs covered by Medicare Part B. In order to qualify for yearly lung cancer screening scans, you must meet the following criteria:
- You are age 50–77.
- You don’t currently present signs or symptoms of lung cancer.
- You are a current smoker or quit smoking within the past 15 years.
- Your tobacco history consists of 20 “pack” years, meaning you smoked one pack (20 cigarettes) a day for 20 years.
- Your doctor or health provider approves the lung screening for you.
What Is The Average Cost Of A CT Scan?
As a general rule, Medicare pays for 80 percent of the Medicare-approved amount for non-laboratory diagnostic tests. The patient is responsible for the remaining 20 percent. The total costs will depend on where the CT scan is performed, meaning whether it is performed on an inpatient or outpatient basis.
For example, CT scans done in ambulatory surgical centers cost Medicare beneficiaries around $8.00. In this case, Medicare Part A covers the test. For CT scans performed in a hospital outpatient setting, the cost averages around $16.00 for Medicare beneficiaries. In this case, Medicare Part B covers the test.
Other factors that may play a role in out-of-pocket cost includes where the Medicare beneficiary lives and whether the Medicare Part B deductible has been met.
Note: These Medicare coverage estimates are based on facility and doctor fees, but additional costs may be involved. Medicare beneficiaries should consult their doctor or insurance company to confirm coverage. This checklist of questions and considerations is a helpful resource.
Do Medicare Advantage Plans Cover CT Scans?
Medicare Advantage plans, also known as MA plans or Medicare Part C, are Medicare plans offered via private insurance companies. These insurance companies are Medicare-approved.
A Medicare Advantage plan has the same covered services as Original Medicare. MA plans also have additional benefits. This means that beneficiaries with an MA plan may have a lower CT scan cost. They will need to confirm coverage.
Note: Learn more about Medicare Advantage plans at this resource.
Do Other Medicare Supplement Insurance Plans Cover CT Scans?
Medicare supplement insurance plans, also known as MedSupp or a Medigap plan, are supplemental insurance policies that “fill in the gaps” of Original Medicare. Since these plans are in addition to Original Medicare, beneficiaries should expect their Medicare plan to still cover 80 percent of CT scan costs, with their financial responsibility being 20 percent, unless they’ve already met their yearly deductible.
As well, Medigap policies may reduce out-of-pocket costs. However, this is all dependent on the specific plan and insurance company.
Note: Learn more about Medigap at this resource.
How Do Prescription Drugs Work With a CT Scan?
At times, prescription medications may be needed to undergo a CT scan. Under Medicare Part B, these medications are not covered. That said, Medicare Part D, which is Medicare’s prescription drug coverage, would cover any prescribed medicines.
Discussing a CT Scan with a Healthcare Provider
If you believe you may benefit from a CT scan, talk with a healthcare provider. Virtually or during an in-office visit, the provider can discuss potential benefits and limitations of this diagnostic tool, payment options, and if insurance will provide reimbursement. Additionally, they can make the decision on if a CT scan is medically necessary, provide a summary of what type of CT scan you may need, and answer any questions asked. If someone cannot be exposed to low levels of radiation, the provider may recommend a MRI or ultrasound instead of a CT scan.
FAQ
What part of Medicare covers CT scans?
Medicare Part A, which is considered Medicare’s “hospital insurance,” covers CT scans if they are ordered during an inpatient stay, such as if a patient is admitted to a skilled nursing facility. Medicare Part B, which is considered Medicare's “medical insurance,” covers CT scans if they are ordered as an outpatient procedure or preventative measure for lung cancer screenings.
Can a CT scan detect heart disease?
A CT scan may check the arteries and heart for signs of coronary artery disease. This type of CT scan is often referred to as a cardiac CT scan and may be different than other types. For example, medical dye or contrast is not used for this type of CT scan. A cardiac CT may only provide limited evidence of other types of heart disease, which is why people often get this test done alongside others.
How is a CT scan done?
A CT scan can be done during a hospital stay or at an appointment to an outpatient clinic. Because a CT scan involves a low level of radiation, it happens in a highly controlled environment and by members of a healthcare team who are trained and often provide a calming energy. For the scan, you usually lie on a table or bed. The scanner then scans specific parts of your body for information that can help a doctor detect the reason behind symptoms. During a scan, you watch the machine as it works. The technician may tell you to hold your breath at certain points, especially if trying to detect if you're at higher risk for heart disease. A doctor will then review the scan's results with you. If you feel uncomfortable before, during, or after the procedure, you can speak to a provider about any questions you have or changes they may be able to apply.
