Medicare Coverage of X-Rays
Medicare Part A covers X-rays of an inpatient in a hospital or skilled nursing facility. For an outpatient, Medicare Part B covers X-rays ordered by a physician for the purpose of diagnosing a medical condition. Medicare doesn't cover X-rays ordered for preventive screening.
What Medicare Pays
For a hospital or skilled nursing facility inpatient, Medicare Part A pays X-ray costs under the same payment rules as for any other hospital charge.
For X-rays taken in a doctor's office, clinic, or other X-ray laboratory not part of a hospital outpatient department, Medicare Part B pays 80 percent of the Medicare-approved amount.
If X-rays are taken in a hospital outpatient laboratory, the patient may be personally responsible for a co-payment to the hospital above the Medicare-approved amount, in addition to the 20 percent of the Medicare-approved amount that Medicare doesn't pay.
Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
- The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper.
- The care must be performed or delivered by a healthcare provider who participates in Medicare.
Original Medicare offers limited coverage for chiropractic services, such as chiropractic exams. You may need to pay the full cost of any X-rays, lab tests, or other services ordered by a chiropractor.