Yes, Medicare Part B covers a head CT scan ordered for an Alzheimer's evaluation when a provider orders it to find or treat a medical problem. Coverage also requires that the scan be reasonable and necessary for that patient. A head CT scan is an X-ray procedure that shows brain structure. An Alzheimer's evaluation is a medical workup that looks for the cause of memory loss and thinking changes.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resources:
- https://www.medicare.gov/coverage/diagnostic-non-laboratory-tests — Use this primary source to verify the official guidance.
- Check eligibility on CMS’s official study page — Use this page to check the study’s participation requirements.
Table of Contents
- Why is brain imaging part of an Alzheimer's workup?
- What does Medicare require for coverage?
- What will you pay for a covered scan?
- How can you avoid a surprise bill?
Why is brain imaging part of an Alzheimer's workup?
A standard Alzheimer's medical workup often includes structural imaging with MRI or CT to evaluate brain structure, according to the Alzheimer's Association in its guide to medical tests for diagnosis. No single test diagnoses Alzheimer's. Physicians combine history, neurological exams, cognitive assessments, brain imaging, and fluid or blood tests.
Doctors use CT, MRI, and PET scans to look for shrinkage or other damage, according to the National Institute on Aging in its explanation of biomarkers for dementia diagnosis. The scans also help find alternate causes such as tumors or stroke. That search for other causes is a practical reason a CT may come early in the workup.
What does Medicare require for coverage?
Medicare Part B covers diagnostic non-laboratory tests including CT scans when a provider orders them to find or treat a medical problem, according to Medicare coverage guidance from the Centers for Medicare & Medicaid Services. A head CT for an Alzheimer's evaluation fits when the ordering provider ties it to the patient's symptoms or suspected condition.
A second CMS rule, National Coverage Determination 220.1, covers head CT scans when medical literature supports the use for the condition. The scan must also be reasonable and necessary for that patient and performed on qualifying equipment.
What will you pay for a covered scan?
For a covered Part B CT in a doctor's office or independent testing facility, the patient pays 20 percent of the Medicare-approved amount after meeting the annual Part B deductible, according to Centers for Medicare & Medicaid Services via Medicare.gov. Ask the facility whether it bills as an office, an independent testing facility, or a hospital outpatient department.
Hospital-outpatient CT copays may exceed 20 percent, up to the Part A inpatient deductible cap. Non-hospital advanced imaging must come from an accredited supplier or Medicare will not pay.
How can you avoid a surprise bill?
Bring the written order, your Medicare card, and a list of current drugs and prior brain scans. If the site is hospital-based, ask for the estimated copay before the appointment.
- Ask the ordering provider to state the medical reason in the order.
- Ask whether CT or MRI is the better fit for your symptoms.
- Ask the imaging site how it will bill the scan.
- Ask whether the supplier is accredited for Medicare advanced imaging.
