An MRI is a relatively simple, non-invasive medical test used for diagnosing or ongoing treatment of certain diseases. Some individuals may not be candidates for an MRI, depending on whether they have certain types of implants or metal in their bodies due to the powerful magnets used during the scan. MRIs are covered by Medicare at 80% of the approved amount if medically necessary and ordered by a medical professional.
An MRI is a non-invasive test using strong magnetics to help diagnose or guide the treatment of certain diseases.
MRIs are different than PET scans, which use injectable radioactive chemicals to see how tissues react to diagnose and guide the treatment of diseases.
Medicare will cover the cost of an MRI if deemed medically necessary and ordered by a licensed healthcare professional.
The coverage is 80% after the Part B deductible is met, and the patient pays the remaining 20%; on average, this can be between $38 and $132.
There are no limits to how many MRIs a Medicare beneficiary can receive as long as medically necessary.
What is an MRI?
An MRI, or Magnetic Resonance Imaging test, is used to diagnose or provide ongoing treatment of certain diseases. It is considered non-invasive and, through electromagnetism, uses powerful magnets to stimulate protons and cause them to change direction with the magnetic field. The magnetic properties of these protons, how fast they realign, and the amount of energy released to do so help healthcare providers tell the difference between tissue types in the body. Different body parts can be examined through MRI. Not just the brain but also the joints, the heart, and other organs.
Because of the strong magnets used, MRI is not recommended for some patients who may have metal in their bodies. Still, every situation may be different and should be assessed individually. If you have a pacemaker, aneurysmal clips, metal implants, or metallic fragments in one or both eyes, you may not be a candidate for an MRI.
On the day of your MRI, you’ll be asked to remove all clothing and items that contain metal. Then, you will lie on a table and go through a scanner that makes loud banging noises. In some cases, you may require medication to help relax you during the procedure, especially if you are claustrophobic. The test may be done with or without contrast. If contrast is needed, you will have an Intravenous (IV) catheter placed by the technologist.
Results are typically unavailable the same day; the scan must be read and interpreted by a radiologist, and the results are sent to your provider.
Are MRIs and PET scans the same?
An MRI and a PET scan are different. A PET scan, or Positron Emission Tomography, uses a “radiotracer” (fluorodeoxyglucose is most used), a radioactive chemical injected through an IV into your body. A PET scanner is used to see how your tissues and organs are working. If any tissues have absorbed large amounts of the radiotracer, this could potentially indicate a problem within your tissues or organs.
PET scans can look at tissues on a more cellular level and detect diseases earlier than an MRI. MRIs cannot see changes at this level of detail and are more helpful in viewing organs and tissues on a larger scale.
|Test Characteristics||MRI||PET Scan|
|Use Radioactive Tracer?||NO||YES|
|Does it detect changes in organs and tissues early?||May take longer for some issues to be detectable on MRI.||Usually picks up on issues earlier than an MRI.|
|Common tissues/conditions scan is used to detect:||Used to look at soft tissues in the body – brain, spinal cord, muscles, nerves, organs – heart, liver, uterus, lymph nodes and blood vessels. To diagnose or treat Tumors, Multiple Sclerosis, Stroke and aneurysms, heart conditions, and liver diseases.||Usually ordered to detect/treat cancers and metastasis, brain disorders, impacts to heart muscle after heart attack, and Alzheimer’s disease.|
|IV required?||Sometimes, if used with contrast.||YES, must use radiotracer.|
|Type of scanner used?||Two types are used: “Closed Bore Scanner – an open circle or doughnut-shaped machine. There are also Open bore scanners with two large flat magnets positioned over and under you, but they may not take as clear of pictures.||Circle/doughnut-shaped scanner|
|How long does exam take?||30 min to 1 hour||About 2 hours|
|When do you usually get the results?||Usually about 24 hours||Usually about 24 hours|
Does Medicare cover PET scans of the brain?
Previously, Medicare would only cover a brain PET beta-amyloid scan for Alzheimer’s diagnosis once per lifetime. However, the Centers for Medicare and Medicaid Services (CMS) lifted this ban in October 2023. PET scans are covered under diagnostic non-laboratory tests in the same way as MRI scans. After meeting your Part B deductible, Medicare will cover the scan at 80% of the Medicare-approved amount, and you would pay 20%; you may also have a hospital copayment if the test is done at a hospital outpatient facility.
How much does an MRI cost?
According to the Kaiser Family Foundation’s Health System Tracker, the average negotiated rate paid by a private or employer insurance plan for an MRI of the lower spine is about $861, with a range of $400 to $1,100, but also can be as high as $4,000 to $5,000. One can expect the MRI cost without insurance to be even higher, as the prices described above are the negotiated rates that the employer-based plan has agreed to pay healthcare facilities. The cost of an MRI depends on several factors, so it’s difficult to give a precise cost. Depending on the area of the body, the facility, whether the scan is being done with or without contrast, and whether you have insurance, as well as what type of insurance you have, can change the price of an MRI significantly.
MRI cost with insurance depends on the type of insurance one has. Employer-based insurance has quite an extensive range of plans with different deductibles and copayments. Medicare coverage also depends on several factors in determining the cost.
Does Medicare Cover an MRI?
Medicare covers diagnostic tests under Part B. Tests such as CT scans, MRIs, X-rays, and PET scans are considered diagnostic, non-laboratory tests covered if ordered by a licensed healthcare provider and medically necessary to diagnose or treat a disease or health condition. Your Part B deductible (the amount you must pay each year before your Medicare plan begins paying for services) must be met first, which in 2023 is $226 for Medicare Part B. You pay 20% of the approved amount for the test, a previously approved rate contracted between Medicare and providers. However, you may also have a copayment if the test is done in a hospital.
Cost of an MRI with Medicare
An MRI of the brain can cost a Medicare beneficiary, on average, between $38 to $132. Again, it depends on several factors, such as the area of the body scanned, if contrast is being used, and the type of facility where the scan is being done. Below is an example chart to compare the average patient responsibility costs of different types of Brain MRIs as a Medicare Beneficiary. If you have Original Medicare, you can look up your portion to be paid for any procedure on the Medicare website:
|Type of MRI||Cost in Ambulatory Surgical Center (20% Patient Responsibility)||Cost in Hospital Outpatient Department (20% Patient Responsibility)|
|MRI of the brain, including the brain stem, with and without contrast (code: 70553)||$59||$94|
|MRI of the brain, including brain stem without contrast (code: 70551)||$38||$60|
|MRI of the brain, including brain stem with contrast (code: 70552)||$55||$90|
|MRI of the brain, including brain stem and skull base, during intracranial procedure with contrast (code: 70558)||$51||$69|
|MRI of the brain, including the brain stem and base of the skull, during the intracranial procedure without contrast (code: 70557)||$84||$132|
|MRI of the brain, including the brain stem and base of the skull, during the intracranial procedure with and without contrast (code: 70559)||$50||$68|
|MRI of the brain, functional MRI requiring administration of neurofunctional testing (code: 70555)||$47||$69|
|MRI of the brain, functional MRI, including administration of repetitive body part movement and possible visual stimulation (code: 70554)||$44||$66|
How many MRIs can one have?
MRIs are considered safe, and since they do not use X-rays, there isn’t any limit that a person can have as they do not cause effects to the body over time as CT scans and X-rays can. Typically, there is no limit on the number of MRIs Medicare will cover if it’s deemed medically necessary and ordered by a licensed medical professional.
In general, Medicare will cover the cost of an MRI at 80% once the Part B deductible is met and ordered by a healthcare provider to diagnose or treat a condition. MRIs and PET scans are different types of tests that can be done to examine organs and tissues within the body, however, both are covered by Medicare. Several factors go into determining the cost of MRIs and other types of tests. For more information, you can visit the Medicare.gov website.
How much will Medicare pay for an MRI?
Medicare will pay 80% of the approved amount, and the beneficiary will cover the other 20% after the Part B deductible is met. The cost to the beneficiary can be anywhere from $38 to $132, on average, for a brain MRI.
What part of Medicare pays for MRI?
Medicare covers non-laboratory diagnostic tests such as PET scans and MRIs under Medicare Part B medical insurance. These tests are covered under Part B when medically necessary and ordered by a licensed healthcare provider. Medicare Part B will also cover some tests used to prevent or detect a healthcare problem early, known as preventive and screening services.
Can MRI results be seen immediately?
No, results are generally made available by the next day, but sometimes may be available several hours after the exam or take longer than one day. The scan is sent to a radiologist to read and interpret the results first, and then the report is sent to your provider for review.
- U.S. Dept of Health and Human Services. Magnetic Resonance Imaging (MRI).
- Cleveland Clinic. MRI (Magnetic Resonance Imaging).
- Medicare.gov. Diagnostic Non-Laboratory Tests.
- Cleveland Clinic. PET Scan.
- CMS.gov. Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease.