Does Medicare Pay for MRI Scans? Coverage, Costs, and Appeals

Yes, Medicare does pay for MRI scans when a doctor orders one to diagnose or monitor a health condition and the scan is performed at an accredited facility. Under Original Medicare, an outpatient MRI falls under Part B, which pays 80% of the approved amount after you meet your annual deductible. If you’re admitted to a hospital, Part A picks it up as part of your inpatient stay. A scan ordered for general screening, or done at a facility that isn’t accredited, is a different story.

When Medicare Covers the Scan

Medicare treats MRI as a diagnostic non-laboratory test under Part B.¹ Three things have to line up:

A qualified physician orders the scan to diagnose an illness or injury, monitor a known condition, or guide treatment. The scan must be reasonable and necessary for your situation.
You have a physician’s order. You can’t self-refer for an MRI and expect Medicare to pay.
The facility is accredited. If you go to a freestanding imaging center, physician’s office, or clinic outside a hospital, the provider must hold Medicare accreditation. Medicare won’t pay a non-accredited provider, and that provider can’t bill you either.¹

CMS’s National Coverage Determination for MRI names common covered uses, including scans of the head, central nervous system, and spine. The list is a general guideline, not the outer limit, so coverage extends to other body areas when your doctor can justify the clinical need.²

When Medicare Won’t Pay

CMS has specifically determined that MRI scans of cortical bone and calcifications are not reasonable and necessary, so those are non-covered outright. Coverage restrictions also apply for patients with cardiac pacemakers or metallic clips on vascular aneurysms unless specific FDA-labeling or clinical study exceptions apply, and MRI during a viable pregnancy is not covered.²

Beyond those specific exclusions, denials tend to fall into a few patterns:

No documented medical necessity. A scan ordered without symptoms or a suspected condition reads as screening, which Medicare doesn’t consider necessary.
Non-accredited facility. Same rule as above, and the practical consequence is a scan Medicare won’t touch.¹
Frequency. Medicare can deny follow-up MRIs it considers too frequent for your condition, even when your doctor recommends them.

If you’re on Medicare Advantage, add one more: missing prior authorization. Many Advantage plans require it before an MRI, and skipping that step can trigger a denial on a scan that would otherwise have been covered. Check your plan documents or call the number on your card before scheduling.³

What You’ll Pay in 2026

Coverage is only half the answer. What lands on your bill depends on which part of Medicare applies.

Inpatient MRIs Under Part A

An MRI ordered during a hospital admission is bundled into your Part A cost-sharing. The inpatient hospital deductible for 2026 is $1,736 per benefit period.⁴ If you’ve met that already for the benefit period, the MRI adds nothing for the first 60 days. Daily coinsurance of $434 kicks in for days 61 through 90, and $868 per day for lifetime reserve days.⁵

Outpatient MRIs Under Part B

Most MRIs happen on an outpatient basis, and Part B covers both the facility and equipment charges and the radiologist’s reading of the images.¹ You first meet the annual Part B deductible, which is $283 in 2026.⁴ After that, Medicare pays 80% of the approved amount and you pay 20%.⁶

That 20% has no cap under Original Medicare, which matters because MRI approved amounts can run high. Where you go also affects the number. Hospital outpatient departments carry higher facility fees than freestanding imaging centers, so the 20% you owe is calculated against a bigger base.⁷

Medicare Advantage

Medicare Advantage plans must cover everything Original Medicare covers, including medically necessary MRI scans.³ They set their own cost-sharing, though. Many use a flat copay instead of a percentage, and many use provider networks, so an out-of-network imaging center can cost more or not be covered at all. Your plan’s schedule of benefits has the specific number.

Bringing the Bill Down

Under Original Medicare, the single most effective move is asking your doctor whether a freestanding imaging center can do the scan. The approved amount tends to be lower than at a hospital outpatient department, and your 20% follows the approved amount down. Medicare’s Procedure Price Lookup at Medicare.gov lets you compare costs by facility type and zip code before you book.⁷

Confirm two things when you call the imaging center: that they’re accredited, and that they accept Medicare assignment. Accreditation is what makes the claim payable at freestanding centers, clinics, and physician practices.¹ Assignment means the provider agrees to charge only the Medicare-approved amount. Providers who don’t accept assignment can bill you more than the standard 20%.⁶

A Medigap policy handles the coinsurance gap directly. Plans A, B, C, D, F, G, and M cover 100% of the Part B coinsurance, so the 20% you’d otherwise owe on the MRI is picked up. Plan K covers 50%, Plan L covers 75%, and Plan N pays 100% aside from certain office and emergency room copays. Medigap only starts paying coinsurance after you’ve met the Part B deductible, unless your plan also covers that deductible; Plans C and F do, but Plan F isn’t available to people who became newly eligible for Medicare on or after January 1, 2020.⁸

If Your Claim Gets Denied

You have the right to appeal every denial. The Medicare Summary Notice (for Original Medicare) or the Explanation of Benefits (for an Advantage plan) will state the reason. The usual suspects are lack of medical necessity documentation, missing prior authorization, and facility accreditation issues.⁹

Most MRI denials resolve at the first level. File a redetermination with the Medicare Administrative Contractor within 120 days of the denial notice, and attach a letter from your ordering doctor explaining why the scan was clinically necessary, along with the clinical notes that support it.¹⁰ If that doesn’t get it overturned, you can escalate to a reconsideration by a Qualified Independent Contractor, and from there to an Administrative Law Judge hearing when the amount in dispute meets the $200 threshold for 2026.¹¹

Every state has a free State Health Insurance Assistance Program (SHIP) with counselors who handle appeals like this one. They’re the right first call if the process feels opaque.

1
Medicare.gov. Diagnostic Non-Laboratory Tests
2
Centers for Medicare & Medicaid Services. National Coverage Determination 220.2 – Magnetic Resonance Imaging
3
Medicare. Compare Original Medicare and Medicare Advantage
4
CMS.gov. 2026 Medicare Parts A and B Premiums and Deductibles
5
Centers for Medicare & Medicaid Services. MM14279 – Medicare Deductible, Coinsurance and Premium Rates CY 2026 Update
6
Medicare.gov. Costs
7
Medicare.gov. Procedure Price Lookup for Outpatient Services
8
Medicare.gov. Compare Medigap Plan Benefits
9
Medicare. Filing an Appeal
10
Centers for Medicare & Medicaid Services. First Level of Appeal – Redetermination by a Medicare Contractor
11
Federal Register. Medicare Appeals – Adjustment to the Amount in Controversy Threshold Amounts for 2026