Does Medicare Part B pay for MRI?

Yes, Medicare Part B generally covers medically necessary MRI scans as a diagnostic non-laboratory test, paying 80% of the Medicare-approved cost after you meet your Part B deductible, with you paying the remaining 20% (unless you have supplemental insurance like Medigap or Medicare Advantage). Coverage requires the MRI to be ordered by a doctor, deemed medically necessary, and performed by an accredited provider or facility that accepts Medicare assignment.

Does Medicare Part B pay for MRIS?

Key takeaways:

Medicare Part B will cover 80% of the Medicare-approved amount for an authorized MRI. But you will need to pay your annual deductible before Medicare pays its part of the scan. You may be eligible for Medigap supplemental insurance with original Medicare.

Does Medicare Part B require prior authorization for MRI?

Whether you have Original Medicare or Medicare Advantage, you should not need prior authorization for an MRI. However, you can confirm this by speaking with Medicare or your plan provider directly.

Can MRI scans be claimed on Medicare?

Yes, Medicare generally covers medically necessary MRI scans when ordered by a Medicare-accepting doctor, primarily under Part B for outpatient care, with beneficiaries paying 20% of the approved cost after their deductible, though costs vary by facility and plan (Original vs. Advantage).
 

How to get an MRI for free?

Option 1: MSAA will refer you to an imaging center that is under contract with MSAA. This applies to people who have no insurance or cannot afford their insurance costs. MSAA will cover the contracted rate of your MRI(s) in full and will pay the imaging center directly.

Will Medicare Pay For MRI? - Pain Medicine Network

How to get a free MRI scan?

Under the scheme, GPs can refer patients directly for tests including X-ray, dual-energy X-ray absorptiometry (DXA), computed tomography (CT), and magnetic resonance imaging (MRI) at no cost to the patient, with access to the scheme available to the full adult population.

How much does an MRI usually cost out-of-pocket?

A general MRI scan may cost between $460 to $1,200, while an MRI with contrast typically ranges from $381 to $976.

Why would Medicare deny an MRI?

Most Medicare and Medigap plans also require the MRI to be medically necessary for a specific medical condition, not based on personal decisions, which is sometimes referred to as an unlisted magnetic resonance procedure.

Do you need a referral for an MRI with Medicare?

MRI scans are not covered under Medicare if there is no prior authorization from a doctor or if the order was not received from your healthcare provider. Additionally, if the facility providing the MRI scan does not accept Medicare, the service will not be covered.

How to get an MRI covered by Medicare?

Medicare eligible MRI services

Most MRI scans on the MBS require a Specialist or Consultant Physician to request the scan. This is because it would generally be the Specialist or Consultant Physician managing the conditions for which MRI scans can support clinical decisions.

Why are MRIs denied by insurance?

Insurance denies MRIs primarily for lack of documented medical necessity, meaning they believe a cheaper test (like X-ray/CT) or conservative care (PT/meds) should be tried first, or the paperwork wasn't detailed enough, but also due to administrative issues like missing prior authorization, coding errors, or using out-of-network providers, all to control costs and follow their own guidelines. 

Can I negotiate the price of an MRI?

Yes, you may be able to negotiate lower MRI costs by asking for discounted payment options or self-pay rates.

Does Medicare require prior approval for an MRI?

Yes, while Original Medicare generally doesn't require prior authorization for MRIs if medically necessary, Medicare Advantage (Part C) plans often do, and the process involves your doctor using a Clinical Decision Support Mechanism (CDSM) to check Appropriate Use Criteria (AUC) before approval to ensure it's needed and not an unnecessary service, thanks to rules from the Protecting Access to Medicare Act (PAMA). Always check with your specific plan and doctor to avoid unexpected costs.
 

How do I get my insurance to approve an MRI?

Insurance providers frequently cover MRIs, provided patients have prior authorization for the imaging. Giving the insurer further information regarding the reason the doctor recommended the scan and the circumstances, including an injury that resulted in the order, is part of the prior authorization procedure.

Why is it so hard to get approved for an MRI?

Some reasons MRI scans might not be approved include: Lack of medical necessity as per established guidelines. Insufficient clinical information to justify the MRI. Insurance coverage issues or prior authorization problems.

What to do when insurance won't cover MRI?

If your scan is denied, talk to your doctor about appealing the decision. Often, a more detailed explanation of your symptoms and history can turn things around. Ask your provider to include specific reasons why a standard MRI won't be enough. Second, call your insurance provider directly.

What is the cheapest way to get an MRI?

To get the cheapest MRI, use online marketplaces like MDsave to compare cash prices at freestanding imaging centers, not hospitals, as they have lower overhead and often match Medicare rates, plus ask for self-pay discounts and an online referral via services like Sesame Care to avoid insurance complexities. 

How much does Medicare pay for MRI of knee?

Medicare typically pays 80% of the approved cost for an outpatient knee MRI under Part B after you meet your deductible (around $257 in 2025), leaving you with 20%; inpatient MRIs in a hospital might be fully covered under Part A after its deductible (around $1,676 in 2025), but your exact out-of-pocket cost depends on the facility and if you have Medigap or Medicare Advantage, with average out-of-pocket costs often around $50-$90. 

How long does an MRI typically take?

An MRI typically takes 30 to 60 minutes, but can range from 15 to 90 minutes or more, depending on the body part, the detail needed, and whether contrast dye is used. Smaller joints (like knees, shoulders) can be shorter (20-45 mins), while complex areas (brain, heart, abdomen) or those requiring contrast can take longer (up to 90 mins or more). 

What is the normal cost of an MRI?

Standard MRI scans in India cost between ₹5,000 – ₹20,000 because different factors influence their price. 2. Does The Cost Of An MRI Scan Vary By City? Yes, the prices of MRI scans show wide differences between cities because cities have different living costs and access to state-of-the-art medical centres.

How do you get covered for an MRI?

Private health insurance covers medical imaging services for private hospital inpatients (ie patients who are admitted to a private hospital) only. The level of coverage depends on the individual health fund and any agreements that may be in place.

Will insurance cover an MRI without a referral?

Insurance Coverage: Insurance companies often require a referral to cover the costs of an MRI. This is to ensure that the imaging procedure is part of a medically necessary treatment plan and not an unnecessary or exploratory test.

Can I negotiate MRI costs?

Direct Negotiation

Another way to save money on your MRI is to negotiate directly with the imaging center. Depending on the location, they may be able to give you a lower rate. It pays to shop around because you'll know what other providers are charging, and one center may offer you a lower rate to earn your business.

Is it worth paying for a private MRI?

Private MRI scan centres typically offer faster results than traditional hospital-based imaging centres. At Vista Health, for example, patients can receive their results within 3 working days of their scan, allowing for prompt follow-up care if necessary.