Your Medicare Coverage

Is my test, item, or service covered?

Diagnostic tests

How often is it covered?

Diagnostic laboratory tests

Medicare Part B (Medical Insurance) covers medically necessary clinical diagnostic laboratory tests, when your doctor or practitioner orders them. These tests are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare also covers some preventive services to help prevent, find, or manage a medical problem.

Diagnostic non-laboratory tests

Part B covers diagnostic non-laboratory tests when these apply:

  • Your doctor or other health care provider orders them.
  • They're ordered as part of treating a medical problem.

Examples of diagnostic non-laboratory tests include CT scans, MRIs, EKGs, X-rays, and PET scans. These tests are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare also covers some preventive services to help prevent, find, or manage a medical problem.

Who's eligible?

All people with Part B are covered.

Your costs in Original Medicare

Diagnostic laboratory tests

You generally pay nothing for Medicare-covered diagnostic laboratory tests.

Diagnostic non-laboratory tests

You pay 20% of the Medicare-approved amount for covered diagnostic non-laboratory tests and X-rays done in these:

  • Your doctor's office
  • An independent testing facility

The Part B deductible applies.

You pay a copayment for diagnostic non-laboratory tests and X-rays done in the hospital outpatient setting.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • Whether your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service
Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

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