Does Medicaid Cover X-Rays?
- Does Medicaid cover X-rays? Medicaid pays some or all of the cost for many diagnostic services. Find out about Medicaid benefits for X-rays in your state.
X-rays are a valuable tool for doctors to diagnose many health conditions. Along with several other imaging tests, X-rays can help medical professionals spot problems from broken bones to some types of cancer. Getting an X-ray can be expensive for many people, but it is usually a covered benefit for most health insurance plans. Medicaid can pay for X-rays as a needed diagnostic service when a doctor orders the procedure, but some restrictions may apply to full Medicaid coverage.
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Does Medicaid Cover X-Rays?
Medicaid pays for X-rays and other diagnostic procedures when the doctor deems it necessary for your treatment. When getting an X-ray image is part of the normal treatment protocol for your condition, the doctor can request a set of films from any provider that is authorized to bill Medicaid in your state. If you are a Medicaid beneficiary, the usual procedure is to present your insurance card at the time you sign in to get the X-rays done. The facility then bills Medicaid just like with any other medical procedure you get.
Services Medicaid Covers
Medicaid services vary by state because the program is administered at the state level. As a rule, Medicaid in every state pays for necessary services ordered by your doctor, provided they are delivered at a site that is authorized to bill Medicaid. Radiology services most Medicaid plans cover typically include:
- CAT scans
- CT scans
- PET scans
- Whole-body irradiation as a necessary treatment for cancer and other conditions
Does Medicaid Cover Radiology?
Medicaid can pay for most of the services offered by radiologists and radiology departments. As long as the radiology services you're getting have been ordered by your doctor, you can generally expect Medicaid to pick up 80% of the cost. Elective procedures are not paid for by Medicaid, and independent radiology clinics must be enrolled with Medicaid in your state before they can accept your coverage for payment.
While Medicaid is generally willing to cover the cost for necessary medical services provided by a radiologist, not every procedure is automatically paid for. If, for example, your doctor has a choice between ordering a set of X-rays and asking for an MRI, a CAT scan or another diagnostic service, most Medicaid programs are willing to pay only for the most cost-effective option.
How Many Visits Does Medicaid Cover?
Medicaid programs in every state pay all of the cost for necessary medical treatment. This is true even if you have to get multiple X-rays done. While there is no set maximum number of visits you can make to an X-ray clinic or radiology department, you may eventually be asked to arrange preapproval for future visits if you get an excessive number of scans.
Can Medicaid Refuse to Cover X-Rays?
Medicaid doesn't always pay for X-rays, but the circumstances that can lead to a denial of payment are relatively rare. If you get a set of X-rays done without a doctor's order, for example, you may be refused coverage for the procedure and have to pay out of pocket. Even if your doctor orders the X-rays, Medicaid can't pay a provider that is not enrolled with the state and authorized to bill the program. Some private radiology clinics fall into this category, so it's important to check beforehand.
Some Medicaid beneficiaries have an annual share of cost that's due before normal Medicaid benefits kick in. If, for instance, you have an annual coinsurance requirement of $500, you may have to pay for all medical and diagnostic procedures up to that point, including X-rays. After you meet your share of cost, Medicaid does typically pay 100% of the cost of your X-rays.