Medicare Coverage for Diagnostic Imaging Explained

If you are on Medicare, understanding your imaging coverage can save you stress and surprise bills. The good news: Medicare covers most medically necessary diagnostic imaging, and Advanced Medical Imaging in Seminole, FL accepts Medicare as well as most Medicare Advantage plans.

What Does Original Medicare Cover?

Part B — Outpatient Imaging Medicare Part B covers diagnostic imaging when it is ordered by your doctor and considered medically necessary. This includes:

• MRI — brain, spine, joints, and other areas when ordered by your physician
• CT scans — for diagnosing conditions from kidney stones to cancer
• X-rays — for fractures, chest evaluation, and other conditions
• Ultrasound — diagnostic ultrasound including abdominal, vascular, and thyroid studies
• Echocardiograms — heart ultrasound to evaluate cardiac function

Preventive Screenings Covered at No Cost Some imaging tests are covered as preventive screenings with no out-of-pocket cost (no deductible, no coinsurance) under Medicare:

• Screening mammogram — covered annually for women 40 and older. Medicare covers 3D mammography the same as 2D.
• Low-dose CT lung cancer screening — covered annually for adults 50–77 who meet smoking history criteria
• DEXA bone density scan — covered once every 24 months for eligible patients (postmenopausal women and others at risk for osteoporosis)

What You Typically Pay For diagnostic (non-screening) imaging under Original Medicare: - You pay the Part B deductible ($257 in 2026) - After the deductible, you pay 20% coinsurance of the Medicare-approved amount - The facility (AMI) bills Medicare directly for the remaining 80%

If you have a Medigap (supplemental) policy, it may cover part or all of your coinsurance and deductible.

Medicare Advantage Plans

If you have a Medicare Advantage plan (Part C), your imaging coverage depends on your specific plan. By law, Medicare Advantage plans must cover everything Original Medicare covers, but they may:

• Require prior authorization before certain imaging exams
• Have different copays or coinsurance amounts
• Require you to use in-network providers
• Have additional coverage for services Original Medicare does not cover

Important: Always check with your Medicare Advantage plan before scheduling to confirm that AMI is in your network and whether your exam requires prior authorization.

Common Medicare Imaging Scenarios

Scenario 1: Annual Screening Mammogram A 65-year-old woman schedules her annual mammogram. Under Medicare Part B, this is a covered preventive service — $0 out of pocket, no deductible applies.

Scenario 2: MRI for Back Pain A doctor orders a lumbar spine MRI for a 70-year-old patient with chronic back pain. Medicare Part B covers this as a diagnostic test. After meeting the annual deductible, the patient pays 20% of the Medicare-approved amount.

Scenario 3: DEXA Scan for Osteoporosis A 68-year-old postmenopausal woman gets a DEXA scan to check bone density. If it has been at least 24 months since her last DEXA, Medicare covers it as a preventive screening at $0 cost.

How AMI Works With Medicare

At Advanced Medical Imaging, we:

• Accept Original Medicare (Part B) and most Medicare Advantage plans
• Verify your benefits before your appointment so you know what to expect
• Handle billing directly with Medicare — we submit claims on your behalf
• Help with prior authorizations when your plan requires them
• Provide cost estimates upfront when possible

Our team is experienced with Medicare billing and can answer your coverage questions when you call to schedule.

Tips for Medicare Patients

1. Bring your Medicare card (or Medicare Advantage card) to every appointment
2. Know your plan type — Original Medicare vs. Medicare Advantage
3. Ask about prior authorization if you have a Medicare Advantage plan
4. Schedule preventive screenings — they are free and can catch problems early
5. Keep records of your Explanation of Benefits (EOB) statements

For more information about Medicare coverage, visit Medicare.gov or call 1-800-MEDICARE.

Schedule Your Imaging Appointment

Have questions about Medicare coverage for your imaging exam? Call (727) 398-5999 — our team will verify your benefits and help you understand your costs before your visit.

Schedule online at Advanced Medical Imaging in Seminole, FL.