X-rays are among the most commonly ordered diagnostic tests in healthcare, helping doctors identify everything from broken bones to lung infections. If you're a Medicare beneficiary, understanding when and how your coverage applies to X-ray services can help you avoid unexpected medical bills and make informed healthcare decisions.
Medicare coverage for X-rays varies depending on which part of Medicare you have and where you receive the service. Whether you need an X-ray in the hospital, at your doctor's office, or at an imaging center, knowing your coverage options and potential costs is essential for managing your healthcare expenses effectively.
Understanding Medicare Coverage for X-Ray Services
Medicare generally covers X-rays when they're medically necessary and ordered by a qualified healthcare provider. The coverage depends on whether you receive the X-ray as an inpatient in a hospital, as an outpatient, or in other specific healthcare settings.
Medical necessity is a key factor in Medicare coverage. This means your doctor must order the X-ray to diagnose a medical condition, monitor treatment progress, or rule out potential health issues. Routine screening X-rays without symptoms or medical indication typically aren't covered by Medicare.
Medicare Part A Coverage for Inpatient X-Rays
When you're admitted to a hospital as an inpatient, Medicare Part A covers X-rays as part of your hospital stay. These diagnostic services are included in the overall hospital charges, so you won't receive separate bills for individual X-rays performed during your admission.
Under Medicare Part A, you'll pay the hospital deductible for each benefit period, which is $1,676 in 2025. After meeting this deductible, Medicare covers 100% of covered hospital services, including X-rays, for the first 60 days of your stay. If your hospital stay extends beyond 60 days, additional coinsurance may apply.
Emergency room X-rays are typically covered under Medicare Part A if you're subsequently admitted to the hospital. However, if you're treated and released from the emergency room without being admitted, the X-ray would likely fall under Medicare Part B outpatient coverage instead.
Medicare Part B Coverage for Outpatient X-Rays
Medicare Part B covers X-rays performed in outpatient settings, including doctor's offices, imaging centers, hospital outpatient departments, and ambulatory surgical centers. This coverage applies when the X-ray is medically necessary and ordered by a Medicare-enrolled healthcare provider.
For 2025, Medicare Part B has an annual deductible of $257. Once you've met this deductible, you typically pay 20% of the Medicare-approved amount for outpatient X-ray services, while Medicare covers the remaining 80%. There's no yearly limit on how much you might pay out-of-pocket under Original Medicare Part B.
The actual cost you'll pay depends on several factors, including the type of X-ray, the facility where it's performed, and whether your healthcare provider accepts Medicare assignment. Providers who accept assignment agree to Medicare's approved payment amount, which can help control your costs.
Special Considerations for Chiropractic and Dental X-Rays
Medicare coverage for X-rays ordered by chiropractors has specific limitations. While Medicare Part B covers chiropractic treatment for subluxation of the spine, it generally doesn't cover X-rays ordered solely by chiropractors for diagnostic purposes. However, if a medical doctor orders an X-ray that a chiropractor uses to support treatment, Medicare may provide coverage.
Dental X-rays fall under a different category entirely. Original Medicare typically doesn't cover routine dental care, including dental X-rays. However, there are limited exceptions when dental X-rays are necessary for covered medical treatments, such as before certain surgeries or cancer treatments.
If you need regular dental care, including dental X-rays, you might consider purchasing separate dental insurance or exploring Medicare Advantage plans that include dental benefits.
Medicare Advantage and X-Ray Coverage
Medicare Advantage (Part C) plans must provide at least the same coverage as Original Medicare, but many offer additional benefits. These plans often have different cost structures for X-ray services, potentially including lower copayments or coinsurance rates compared to Original Medicare.
Some Medicare Advantage plans may cover services that Original Medicare doesn't, such as certain types of screening X-rays or X-rays in specific healthcare settings. However, you'll need to receive care from providers within your plan's network to receive full coverage benefits.
Medicare Advantage plans may also have prior authorization requirements for certain X-ray procedures, meaning your plan must approve the service before you receive it. Always check with your plan before scheduling non-urgent X-ray services to understand any requirements or limitations.
How Medigap Insurance Helps with X-Ray Costs
Medigap (Medicare Supplement Insurance) policies can help reduce your out-of-pocket costs for Medicare-covered X-ray services. These policies work alongside Original Medicare to cover some or all of the deductibles, coinsurance, and copayments that you would otherwise pay.
For example, if you have Medigap Plan F or Plan G, your policy would typically cover the 20% coinsurance you'd pay under Medicare Part B for outpatient X-rays. Plan G also covers the Part B deductible after you've had the policy for six months, while newer Plan G policies require you to pay the Part B deductible first.
Medigap policies don't work with Medicare Advantage plans, so you can only use them if you have Original Medicare Parts A and B. If cost predictability is important to you, a Medigap policy can provide valuable financial protection for diagnostic services like X-rays.
Tips for Managing X-Ray Costs Under Medicare
To minimize your costs for X-ray services, consider having the procedure performed at a facility that accepts Medicare assignment. These providers agree to Medicare's approved payment rates, which can significantly reduce your out-of-pocket expenses compared to non-participating providers.
If you have Medicare Advantage, stay within your plan's provider network whenever possible. Out-of-network X-rays may result in higher costs or may not be covered at all, depending on your plan's specific rules and whether the service is considered urgent or emergent.
Keep track of your Medicare Part B deductible throughout the year. Once you've met the annual deductible, your costs for additional X-ray services will be more predictable, typically involving only the 20% coinsurance under Original Medicare.
Frequently Asked Questions
Does Medicare Part A cover X-rays during a hospital stay and what costs can I expect?
Yes, Medicare Part A covers X-rays during inpatient hospital stays as part of your overall hospital services. You'll pay the hospital deductible ($1,676 in 2025) for each benefit period, and then Medicare covers 100% of covered X-rays and other hospital services for the first 60 days of your stay.
How much do X-rays cost under Medicare Part B outpatient coverage in 2025?
Under Medicare Part B, you'll first pay the annual deductible of $257 in 2025. After meeting the deductible, you typically pay 20% of the Medicare-approved amount for outpatient X-rays, while Medicare covers the remaining 80%. The exact cost depends on the type of X-ray and the facility where it's performed.
Are X-rays ordered by chiropractors or dental X-rays covered by Medicare?
Medicare generally doesn't cover X-rays ordered solely by chiropractors, though there may be exceptions if a medical doctor orders the X-ray. Dental X-rays are typically not covered by Original Medicare, except in rare cases where they're necessary for covered medical treatments like certain surgeries or cancer care.
How do Medicare Advantage (Part C) plans differ in covering X-rays compared to Original Medicare?
Medicare Advantage plans must provide at least the same X-ray coverage as Original Medicare, but often have different cost structures, such as fixed copayments instead of percentage coinsurance. Some plans may offer additional benefits or require prior authorization. You must typically use in-network providers to receive full coverage benefits.
Can Medigap plans help reduce out-of-pocket costs for Medicare-covered X-rays?
Yes, Medigap policies can significantly reduce your X-ray costs by covering the deductibles, coinsurance, and copayments that Original Medicare doesn't pay. For example, most Medigap plans cover the 20% coinsurance for Part B services like outpatient X-rays, making your costs more predictable and manageable.
