Medicare Part B covers CT Head at 80% after the Part B deductible. Here's the full cost-sharing breakdown, admission status rules, and Medicare Advantage differences.
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Does Medicare Cover CT Head? (2026)
Yes. Medicare Part B covers medically necessary CT Head at 80% after you meet the Part B deductible. You pay the other 20% as coinsurance, with no annual out-of-pocket maximum under Original Medicare.
Quick answer:
- Medically necessary CT Head (Original Medicare): Part B — 80% after deductible
- Your share: 20% coinsurance (no cap under Original Medicare)
- Prior authorization: Not required under Original Medicare; varies under Medicare Advantage
- Annual Part B deductible (2026): $257
What Medicare Covers
Medicare Part B covers diagnostic imaging that is:
Medical bills contain errors in roughly 80% of cases. Most go uncontested.
The free Dispute Kit gives you the exact letter templates, billing-error checklist, and the specific language that gets charges reviewed — the same process that's recovered thousands of dollars for patients who used it.
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- Ordered by a Medicare-enrolled physician for a documented medical reason
- Performed at a Medicare-enrolled facility
- Medically necessary per LCD (Local Coverage Determination) criteria
CT Head is always diagnostic under Medicare — there is no $0 preventive category for CT Head as there is for mammograms or colonoscopies.
Your Medicare Cost for a CT Head
| Phase | What you pay |
|---|---|
| Before Part B deductible ($257/year) is met | 100% of the Medicare allowed amount |
| After Part B deductible | 20% of the Medicare allowed amount |
| With Medigap supplement | Medigap pays the 20% coinsurance in full |
| With Medicare Advantage | Varies by plan — may be a flat copay |
The Medicare allowed amount for CT Head varies by setting:
- Hospital outpatient (HOPD): Higher allowed amount
- Freestanding imaging center: Lower allowed amount; usually lower cost to you
Medicare Advantage (CT Head)
Medicare Advantage plans (Part C) cover the same medically necessary services as Original Medicare, but apply their own cost-sharing structures. Differences from Original Medicare:
- Prior authorization: Medicare Advantage plans CAN require prior authorization for CT Head — a critical difference from Original Medicare
- Network restrictions: You must use in-network facilities (most MA plans)
- Cost sharing: May be a flat copay ($50–$200 typical) instead of 20% coinsurance
- Out-of-pocket maximum: MA plans have an annual cap; Original Medicare does not
Two Bills Under Medicare
Like commercial insurance, Medicare CT Head generates two claims:
- Technical fee (facility): Paid at 80% by Medicare
- Professional fee (radiologist): Paid at 80% by Medicare separately
Both the facility and the radiologist must be enrolled in Medicare (accept Medicare assignment) for Medicare to cover them.
Related Cost Information
Related: Is a CT Head covered by insurance? → · CT Head billing surprises →
Medical bills contain errors in roughly 80% of cases. Most go uncontested.
The free Dispute Kit gives you the exact letter templates, billing-error checklist, and the specific language that gets charges reviewed — the same process that's recovered thousands of dollars for patients who used it.
We'll email it to you immediately. No account required, no spam.
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About the Author
John Caruso, FSA, MAAA
Healthcare actuary with 20+ years of experience in insurance pricing, medical billing systems, and healthcare cost analytics.
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