Yes. Medicaid covers MRI and CT scans when they’re medically necessary, in every state. But Medicaid is run by each state, so the details vary: whether you need prior authorization, which imaging centers you can use and whether you pay a small copay. Here’s how it works and what to do if a scan is denied.
Key takeaways
- Federal law requires every state Medicaid program to cover X-ray services, outpatient hospital services and physician services, which include diagnostic imaging such as MRI and CT.
- Your doctor must order the scan, and it must be medically necessary.
- Most states and Medicaid health plans require prior authorization for MRI, CT and PET scans.
- Copays for imaging are usually small or zero, and children don’t pay copays.
- If a scan is denied, you have the right to appeal and to ask for a state fair hearing.
Why Medicaid covers imaging everywhere
Medicaid is a joint federal and state program. Federal law sets a list of mandatory benefits that every state must cover. According to Medicaid.gov, these include:
- Laboratory and X-ray services.
- Outpatient hospital services.
- Physician services.
- Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for children.
Diagnostic imaging, including MRI and CT, falls under these benefits. States decide the details, such as which tests need approval and how much they pay providers.
Prior authorization
Most Medicaid programs require prior authorization for advanced imaging: MRI, CT, PET and nuclear medicine scans. Your doctor’s office usually requests it. The plan then checks whether the scan meets its medical necessity rules.
Many states use private companies to review imaging requests, and many Medicaid enrollees are in managed care plans that set their own approval steps. Emergency scans, such as a CT in the emergency room, don’t need prior authorization.
Under a federal rule that took effect in 2026, Medicaid programs and Medicaid managed care plans must generally decide prior authorization requests within 7 calendar days, or 72 hours for urgent requests, and give a specific reason if they deny one.
Do you pay anything?
Often very little or nothing. Federal rules limit Medicaid cost sharing:
- Children can’t be charged copays.
- Emergency services, pregnancy-related services and family planning are exempt.
- For people with incomes at or below the federal poverty level, copays for outpatient services are limited to small, nominal amounts.
- Total cost sharing can’t exceed 5% of family income.
Each state sets its own amounts within these limits, and many charge nothing for imaging. Your state Medicaid office or health plan can tell you what applies to you.
Upcoming change: under the One Big Beautiful Bill Act, starting October 1, 2028, states must charge cost sharing of up to $35 per service to some adults covered through Medicaid expansion with incomes between 100% and 138% of the federal poverty level. Primary care, prescription drugs and rural health clinic services are exempt. Check with your state for how this will apply to imaging.
Where you can get your scan
Medicaid only pays providers that accept Medicaid. If you’re in a Medicaid managed care plan, you’ll usually need to use an in-network imaging center or hospital.
Before your appointment:
- Confirm the imaging center accepts your Medicaid plan.
- Confirm prior authorization has been approved.
- Ask whether there’s any copay.
If you need help getting to your appointment, Medicaid also covers non-emergency transportation to medical care. Call your plan or state Medicaid office to arrange a ride.
Imaging for children on Medicaid or CHIP
Children under 21 on Medicaid have extra protection through EPSDT. States must cover the services a child needs to diagnose or treat a condition when they’re medically necessary, even if the state limits that service for adults. This includes MRI and CT.
Children in the Children’s Health Insurance Program (CHIP) also have imaging coverage, though CHIP rules can differ by state.
If your child needs a scan, ask whether it can be done with an imaging method that doesn’t use radiation, such as ultrasound or MRI. Our guide to medical radiation and children explains what parents should know.
If your scan is denied
- Read the denial notice. It should explain the reason and how to appeal.
- Talk to your doctor. They can send more records or ask for a peer-to-peer review.
- Appeal to your health plan. If you’re in Medicaid managed care, you usually appeal to the plan first.
- Ask for a state fair hearing. If the plan upholds the denial, or if you’re in fee-for-service Medicaid, you can ask your state for a fair hearing.
- Ask for a fast decision if it’s urgent. If waiting could seriously harm your health, ask for an expedited appeal.
Deadlines are short, so act quickly. Our step-by-step guide to MRI prior authorization denials covers this in more detail.
Medicaid and Medicare together
If you have both Medicare and Medicaid (dual eligible), Medicare usually pays first. Medicaid may then cover some or all of your Medicare deductible and coinsurance for the scan.
Frequently asked questions
Does Medicaid cover a full-body MRI scan? No, not as an elective screening. Medicaid covers scans that your doctor orders because they’re medically necessary.
Does Medicaid cover PET scans? Yes, when medically necessary, usually with prior authorization. Coverage details vary by state.
How long does Medicaid prior authorization take for an MRI? It varies, but since 2026 most Medicaid programs and plans must decide standard requests within 7 calendar days and urgent ones within 72 hours.
Can I get an MRI on Medicaid without a referral? You need a doctor’s order for an MRI. Some managed care plans also require a referral from your primary care provider.
Sources
- Medicaid.gov: Mandatory and optional Medicaid benefits.
- Medicaid.gov: Cost sharing out-of-pocket costs.
- Medicaid.gov: Early and Periodic Screening, Diagnostic, and Treatment.
- Morgan Lewis: One Big Beautiful Bill Act key final Medicaid changes explained (July 2025).
- Association of American Medical Colleges (AAMC): Summary of the CMS Interoperability and Prior Authorization Final Rule.
This article is for general information only. Medicaid rules differ by state and change over time. Contact your state Medicaid office or health plan for the rules that apply to you.