Question 1

Does Medicare cover lumbar spine MRI?

Accepted Answer

Yes. Medicare Part B covers lumbar spine MRI (CPT 72148 without contrast) when medically necessary — typically for evaluation of back pain with radiculopathy (leg pain/weakness), suspected disc herniation, or spinal stenosis. Medicare pays 80% of the approved amount; you owe 20% after your annual $283 Part B deductible. Medicare may require documentation that conservative treatment has been tried before approving a spine MRI in non-urgent situations.

Question 2

Does Medicare require prior authorization for a spine MRI?

Accepted Answer

Traditional Medicare (Parts A and B) does not require prior authorization for spine MRI — your physician's order and documentation of medical necessity in the chart are sufficient. However, Medicare Advantage (Part C) plans frequently require prior authorization for MRI. If you have a Medicare Advantage plan, confirm prior authorization requirements with your plan before scheduling. Failure to obtain required prior auth can result in claim denial.

Question 3

What is the Medicare cost for a spine MRI at a freestanding imaging center?

Accepted Answer

In 2026, the radiologist fee for lumbar spine MRI (CPT 72148) is approximately $82 nationally (your 20%: $16). The facility fee is $680 at an HOPD (your 20%: $136) or $450 at a freestanding imaging center (your 20%: $90). Total out-of-pocket at a freestanding center without Medigap: approximately $106 per scan. With Medigap Plan G: $0 after the $283 annual deductible. Choosing a freestanding imaging center over an HOPD saves approximately $46 in coinsurance.

Question 4

Why does this calculator show a different amount than Medicare.gov's cost estimate?

Accepted Answer

This calculator may show a higher number than Medicare.gov's "Patient Pays (average)" for several reasons: (1) Deductible timing — this calculator applies the $283 Part B annual deductible if it has not yet been met; Medicare.gov's average assumes many patients have already satisfied theirs. (2) Location adjustment — the radiologist's reading fee is adjusted by your region's Geographic Practice Cost Index (GPCI); in high-cost areas, reading fees run above the national rate. The facility fee is nationally fixed by CMS and should match Medicare.gov exactly. (3) Patient mix — Medicare.gov's "Patient Pays" average includes Medigap enrollees who pay $0 coinsurance, which pulls the reported average below what uninsured Original Medicare patients typically pay. No separate anesthesia bill applies to standard MRI or CT scans.

Cost Component	Medicare-Approved Amount	Your Share (20%)
Surgeon Fee — Lumbar Spine MRI (CPT 72148)	$191	$38
Hospital Outpatient (HOPD) Facility Fee	$243	$49
Ambulatory Surgery Center (ASC) Facility Fee	$123	$25
Anesthesia (estimated)	none	20% of approved

Medicare Lumbar Spine MRI Cost 2026 | Out-of-Pocket Estimator

2026 Medicare Cost Summary — Lumbar Spine MRI (CPT 72148)

What Medicare Pays

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