What types of treatments require an MRI?

Treatments Purpose of the MRI scan Joint investigations If you need an MRI for limb joint analysis or preparation for surgery it can be claimed under the joint investigation component of your health insurance policy. Gastroscopy An MRI may be recommended by your doctor for diagnosing health issues affecting digestive system, including the bowels and oesophagus. Diagnostic imaging A general term for procedures like X-rays, CT scans, MRIs and other imaging techniques, and requires a doctor's referral in order to claim. Health screenings Health screenings are preventative measures used to identify potential health issues. Some extras cover include MRI health screening benefits.

What happens during an MRI?

MRI machines use radio waves and a large magnet to create detailed images of your body's tissue. Here's what you expect during the procedure: A radiographer will explain the process to you before the scan. You'll change into a gown and lie on a table, which will move into the MRI machine's tunnel. The scan will take 15 minutes to an hour. During this time you'll likely hear knocking and buzzing sounds, but you won't feel anything. You may receive a dye injection for clearer images, and you might need to hold your breath for some scans.

Do you need a referral to get an MRI scan?

For Medicare to pay a benefit for an MRI scan, the scan has to be requested by a practitioner the Medicare Benefits Schedule allows to request it. Specialists and consultant physicians can request any MRI item. GPs and other medical practitioners can request the limited set the schedule designates for general practice requests. A small number of dental specialists can also request particular scans, such as the temporomandibular joint and skull base items. A referral from a chiropractor or physiotherapist will not attract a Medicare benefit for an MRI.

Do health insurance and Medicare cover MRI scans?

Who’s this health cover for?

If you need an MRI as an inpatient at a public hospital, Medicare will typically cover the whole cost of your procedure.
Medicare can also pay a partial benefit if you receive an MRI as an outpatient or private hospital inpatient, as long as it's considered medically necessary.
Private healthcare can help fill in the gaps of the MRI if you're a private patient

Does health insurance cover MRI scans?

Yes, health insurance can cover you for MRI scans but it's not in every situation, and it's a little fuzzy. It will depend on whether you receive the MRI as an inpatient or outpatient and where the scan is performed.

Here's a breakdown of the situations where health insurance will or won't pay for an MRI scan:

Inpatient

If you are admitted to the hospital as an inpatient and require an MRI scan during the course of your treatment, hospital insurance can cover the gap between what Medicare pays and the total cost of the scan.
The scan will need to be for the treatment of a condition that your policy covers, however.

Outpatient

Private health insurance won't cover any MRIs that are performed as an out of hospital or as an 'outpatient service'. Medicare may be able to cover a portion of the expenses, but only if the condition the MRI is being used to assess or manage is part of the Medicare Benefits Schedule (MBS).

If your condition isn't, unfortunately, this means that you'll most likely have to pay the full cost of the MRI yourself.

Will Medicare cover an MRI scan?

If you require an MRI as a part of a medically necessary treatment, Medicare covers some, if not all, of the cost of your scan. This includes whether you receive it as an inpatient service or out of the hospital as an outpatient.

How much of your bill Medicare will cover will depend on a couple of things, including whether you receive your scan in a public or private hospital as well as what your radiologist chooses to charge you. Here's how it works:

Inpatient

If the MRI is performed at a public hospital and you're a public patient, Medicare will generally cover the entire cost of the procedure. However, if you are a private patient or at a private hospital, you'll likely only see a partial benefit. This means there will be a gap you have to pay out of your own pocket or with the help of health insurance.

Outpatient

Outside of a hospital, where most MRIs happen, Medicare might cover the cost, depending on the body part and reason for the scan. You may get a partial benefit paid by Medicare. This is set at a certain amount under the MBS, depending on the type of treatment the MRI is being used for.

While in most cases, you'll have to pay a gap on outpatient MRI scans, some radiology clinics may choose to bulk bill. This means you'll only be charged the exact amount Medicare will cover, so you won't have to pay anything out of pocket.

Item number	Purpose of the scan	Fee charged	Medicare benefit
63551	Head scan for a patient 16 years or older to investigate: Unexplained seizures Unexplained chronic headaches with suspected intracranial pathology	$463.80	75%: $347.85 85%: $394.25
63554	Spinal scan for a patient 16 years or older for suspected cervical radiculopathy	$412.25	75%: $309.20 85%: $350.45
63557	Spinal scan for a patient 16 years or older for suspected cervical spine trauma	$566.90	75%: $425.20 85%: $481.90
63560	Knee scan for a patient 16 years or older following acute knee trauma with: Inability to extend the knee suggesting the possibility of acute meniscal tear Clinical findings suggesting acute anterior cruciate ligament tear	$463.80	75%: $347.85 85%: $394.25
63507	Head scan for a patient under 16 years for any of the following: Unexplained seizures Unexplained headaches where significant pathology is expected Paranasal sinus pathology, which has not responded to conservative treatment	$463.80	75%: $347.85 85%: $394.25
63510	Spinal scan for a patient under 16 years following radiographic examination for: Significant trauma Unexplained neck or back pain with associated neurological signs Unexplained back pain where a significant pathology is suspected	$515.30	75%: $386.50 85%: $438.05
63513	Knee scan for a patient under 16 years following radiographic examination for internal joint derangement	$463.80	75%: $347.85 85%: $394.25
63516	Hip scan for a patient under 16 years following radiographic examination for: Suspected septic arthritis Suspected slipped capital femoral epiphysis Suspected Perthes disease	$463.80	75%: $347.85 85%: $394.25
63519	Elbow scan for a patient under 16 years following radiographic examination where a significant fracture or avulsion injury is suspected that will change management	$463.80	75%: $347.85 85%: $394.25
63522	Wrist scan for a patient under 16 years following radiographic examination where scaphoid fracture is suspected	$515.30	75%: $386.50 85%: $438.05

When will Medicare and health insurance not cover an MRI?

As discussed previously, there are many cases where MRIs will be covered by private health insurance and Medicare. The main exception is when the MRI isn't considered medically necessary.

Neither Medicare nor private health insurance will cover you for an MRI scan if it's chosen for an elective cosmetic procedure or for a life insurance underwriting purpose. Always check with your provider to confirm your eligibility for cover before proceeding with a scan.

How much does an MRI cost?

Get a more in-depth look at the costs of MRI scans

What to look for in health insurance policies that cover MRIs

Sections that include MRI. Look for joint investigation, gastroscopy, diagnostic imaging, health screenings and similar terms. Depending on your particular health issues, you might be able to claim the MRI costs against these treatments.
Annual benefit limits. This is the highest dollar amount that can be claimed per year for a certain procedure. They might also be per person, or per family if there are multiple people covered by your policy.
Exclusions. This refers to conditions under which claims won't be paid. Common exclusions include overseas treatment, medically unnecessary scans and scans performed without a doctor's referral.
Pre-existing conditions. This can be a particular concern for seniors, as such conditions may accumulate over the years, slowly limiting your options. You may wish to look at health insurance options for seniors if you're over 65.

Frequently asked questions

Treatments	Purpose of the MRI scan
Joint investigations	If you need an MRI for limb joint analysis or preparation for surgery it can be claimed under the joint investigation component of your health insurance policy.
Gastroscopy	An MRI may be recommended by your doctor for diagnosing health issues affecting digestive system, including the bowels and oesophagus.
Diagnostic imaging	A general term for procedures like X-rays, CT scans, MRIs and other imaging techniques, and requires a doctor's referral in order to claim.
Health screenings	Health screenings are preventative measures used to identify potential health issues. Some extras cover include MRI health screening benefits.

MRI machines use radio waves and a large magnet to create detailed images of your body's tissue. Here's what you expect during the procedure:
- A radiographer will explain the process to you before the scan.
- You'll change into a gown and lie on a table, which will move into the MRI machine's tunnel.
- The scan will take 15 minutes to an hour. During this time you'll likely hear knocking and buzzing sounds, but you won't feel anything.
- You may receive a dye injection for clearer images, and you might need to hold your breath for some scans.
For Medicare to pay a benefit for an MRI scan, the scan has to be requested by a practitioner the Medicare Benefits Schedule allows to request it. Specialists and consultant physicians can request any MRI item. GPs and other medical practitioners can request the limited set the schedule designates for general practice requests. A small number of dental specialists can also request particular scans, such as the temporomandibular joint and skull base items. A referral from a chiropractor or physiotherapist will not attract a Medicare benefit for an MRI.

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Gary Ross Hunter

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Gary Ross Hunter has over 6 years of expertise writing about insurance, including life, health, home, and car insurance. Having reviewed hundreds of product disclosure statements and published over 800 articles, he loves simplifying complex insurance topics for everyday readers. Gary has contributed to major outlets like Yahoo Finance, The Sydney Morning Herald, and news.com.au, and holds a Bachelor of Arts (Honours) in English Literature from the University of Glasgow, along with a Tier 2 General Advice certification, ensuring his work adheres to ASIC’s RG146 standards. See full bio

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Health insurance for MRI scans

Medicare and health insurance can cover you for the cost of an MRI scan as long as it's considered medically necessary, but it depends on where it's performed and what type of patient you are.