Medicare Part B covers MRI Knee at 80% after the Part B deductible. Here's the full cost-sharing breakdown, admission status rules, and Medicare Advantage differences.
The first step in taking control of your healthcare spending is tracking costs using a simple tracker like below, where you can add past or future visits and your insurance information. You can use this for free and can save the forecast by entering your email.
Save your estimate so you know exactly what you'll pay next time →
Does Medicare Cover MRI Knee? (2026)
Yes. Medicare Part B covers medically necessary MRI Knee 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 MRI Knee (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:
Hospital MRI costs run 2–5× more than independent imaging centers. Most patients never knew they had a choice.
Your personalized cost report includes:
- ✓ Why the exact same scan costs $400 at one site and $2,200 at another
- ✓ The separate radiologist bill most patients miss (and how to verify it's in-network)
- ✓ When contrast adds a charge — and when to ask if you need it
- ✓ The questions to ask before scheduling that protect you from surprise bills
- ✓ A real patient billing breakdown, line by line
Free for patients — takes 30 seconds to get.
We'll email it to you immediately. No account required, no spam.
- 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
MRI Knee is always diagnostic under Medicare — there is no $0 preventive category for MRI Knee as there is for mammograms or colonoscopies.
Your Medicare Cost for a MRI Knee
| 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 MRI Knee varies by setting:
- Hospital outpatient (HOPD): Higher allowed amount
- Freestanding imaging center: Lower allowed amount; usually lower cost to you
Medicare Advantage (MRI Knee)
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 MRI Knee — 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 MRI Knee 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 MRI Knee covered by insurance? → · MRI Knee billing surprises →
Hospital MRI costs run 2–5× more than independent imaging centers. Most patients never knew they had a choice.
Your personalized cost report includes:
- ✓ Why the exact same scan costs $400 at one site and $2,200 at another
- ✓ The separate radiologist bill most patients miss (and how to verify it's in-network)
- ✓ When contrast adds a charge — and when to ask if you need it
- ✓ The questions to ask before scheduling that protect you from surprise bills
- ✓ A real patient billing breakdown, line by line
Free for patients — takes 30 seconds to get.
We'll email it to you immediately. No account required, no spam.
Related Articles
Interested in understanding healthcare costs and managing your medical expenses?
- Deductible vs Out-of-Pocket MaximumLearn how insurance cost-sharing works and what you actually pay
- Cost ExplorerBrowse procedures and compare prices across the country
- CT Scan Cost GuideFind detailed CT scan pricing for your state
- MRI Cost GuideCompare MRI pricing and understand imaging costs
- X-Ray Cost GuideCompare X-ray pricing across states—one of the most affordable imaging procedures
- Colonoscopy Cost GuideUnderstand colonoscopy pricing and your out-of-pocket costs by insurance type
- New GuidesExplore our latest healthcare guides on costs, insurance, and medical billing
About the Author
John Caruso, FSA, MAAA
Healthcare actuary with 20+ years of experience in insurance pricing, medical billing systems, and healthcare cost analytics.
Connect on LinkedIn →Ready to take control of your healthcare costs?