Does Medicare Require Precertification For Mri?

Does Medicare Require Precertification For Mri?

No, Medicare does not require precertification for MRI . You can schedule a procedure as soon as you are approved for coverage. However, your doctor may require you to make an appointment and pay a deposit beforehand.

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What is the Medicare deductible?

Medicare requires that you meet a yearly deductible before benefits begin. In 2010 the deductible was $961 for an individual and $1,926 for a couple.

What does Medicare cover for MRI?

Medicare Part B covers MRI scans for diagnostic purposes only. The MRI procedure must be performed by a qualified radiologist. MRI scans are billed on a Cost-to-Charge Ratio (CCR) basis, which means the facility will receive a set amount from Medicare and you will pay the difference. The facility will receive a set amount from Medicare each year to cover the costs of MRI . The amount for 2010 is $1,184.

Medicare Part B also covers the technical component of MRI (TAC), which consists of the equipment, supplies, and radiologist's time and is billed to Medicare separately from the facility charge. The TAC rate for 2010 is $1,833.

What does Medicare not cover?

Medicare does not cover the whole cost of MRI scans. You may be required to pay 20 to 50 percent of the Medicare-approved amount. You may also be required to pay a facility fee in addition to the cost of the MRI scan.

How do I get reimbursed?

Your doctor will file a claim for reimbursement. The doctor's office should submit the claim to Medicare within 60 days of the procedure. If you wish to check the status of your reimbursement, you may call 1-800-MEDICARE or 1-877-690-1012.

What is a Medicare Secondary Payer (MSP) claim?

Because Medicare pays only 80 percent of what an MRI scan costs, many people have private insurance or other potential sources of coverage. If you have insurance through your employer, state, or a private insurance company and the other insurance covers the full cost of your MRI scan, you may need to submit a claim to your secondary payer. Medicare will pay nothing for the scan if your private insurance pays all or part of the cost.

What should I do before I go to the MRI center?

Make sure you have your Medicare card, government issued ID, and any other insurance cards you may have. You will need to submit your insurance information before your exam can be scheduled.

What kind of MRI scan will I have?

There are many types of MRI scans. The most common types are listed below.

Transaxial

This is the most popular type of MRI scan. It is good to have this type of scan for diagnoses of brain tumors, strokes, degenerative diseases, and trauma to the brain and spine.

This is the most popular type of MRI scan. It is good to have this type of scan for diagnoses of brain tumors, strokes, degenerative diseases, and trauma to the brain and spine. Transcranial and Transsphenoidal

This type of MRI is good for diagnosing tumors in the pituitary gland or hypothalamus.

This type of MRI is good for diagnosing tumors in the pituitary gland or hypothalamus. Angiography

This type of MRI is used to make a detailed study of the blood vessels.

This type of MRI is used to make a detailed study of the blood vessels. Myelography

This type of MRI is used for diagnosing diseases of the spinal cord and nerves.

This type of MRI is used for diagnosing diseases of the spinal cord and nerves. Venography

This type of MRI is used to study the veins.

This type of MRI is used to study the veins. Neurography

This type of MRI is used for diagnosing diseases of the brain.

This type of MRI is used for diagnosing diseases of the brain. Brain

This type of MRI is used for diagnosing diseases of the brain. Body

This type of MRI is used for diagnosing diseases of the body.

Who interprets the results of my MRI scan?

A radiologist interprets your MRI scan. The radiologist is a physician who specializes in reading and interpreting medical images.

What should I expect at the MRI center?

Be sure to contact the MRI center to let them know if there are any special circumstances. The MRI center will ask you to provide your insurance information and to fill out any necessary forms.

When you arrive at the MRI center, you will be asked to remove your clothes below your waist and put on a hospital gown. You will also be asked to remove any jewelry or items that may interfere with the MRI scan. You will be asked to lie on a hard, narrow table that slides into a large chamber. You will be asked to hold your breath at certain points during the procedure. Throughout the procedure you will be asked to keep your body still. Your head will be secured with a special head holder. Most MRI procedures last up to 45 minutes.

What are the risks and side effects of having an MRI scan?

Although rare, the following side effects may occur:

Swelling

Some swelling may occur around the area being scanned. This is due to the contrast material used in the scan. The swelling usually goes away within a few days.

Some swelling may occur around the area being scanned. This is due to the contrast material used in the scan. The swelling usually goes away within a few days. Infection

Rarely, an infection may occur where the contrast material is injected.

Rarely, an infection may occur where the contrast material is injected

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