MRI and CT scan denials and bills: how to check and appeal

Your doctor ordered an MRI or CT scan, and your plan turned it down. Or you had the scan, and now 2 bills have arrived for the same day. Both are common, and both can often be fixed.

This guide covers why imaging gets denied, who sends each bill, and what a scan usually costs. It also explains the rules that protect you and how to check each bill against your explanation of benefits (EOB) before you pay.

The bills you'll get

An MRI, CT scan, or other imaging test has 2 parts. Someone takes the pictures, and a radiologist reads them. Depending on where you go, you may get 1 bill or several.

Each bill should have its own EOB from your plan. If a bill has no EOB, the provider may not have sent the claim to your insurer yet.

Why 1 scan can show up as 2 charges

Medicare's billing rules split most imaging codes into a technical part and a professional part. Most private plans use the same codes. You may see these 2-character tags, called modifiers, next to the code on a bill or EOB.

So a hospital bill and a radiologist's bill for the same scan aren't a duplicate. The problem comes when the same part is billed twice. For example, a global bill plus a separate -26 bill for the same scan is worth asking about.

What does it cost?

Imaging prices vary a lot by test, by place, and by plan. The setting matters most. The same scan often costs far more at a hospital outpatient department than at a doctor's office or stand-alone imaging center.

Medicare's Procedure Price Lookup shows national averages for 2026 at hospital outpatient departments. These are Medicare's rates, which are usually lower than private plans pay. They include the facility fee and the doctor's fee.

Private plans usually pay more, and prices differ a lot by place:

• Commercial prices are higher. A 2026 Health Care Cost Institute (HCCI) brief looked at 2022 employer plan claims. MRI prices averaged 307% of what Medicare pays, and CT scans averaged 257%.
• Hospitals cost more than offices. In the same HCCI data, imaging at hospital outpatient departments cost 2 to 4 times more than at doctor's offices. For the most complex level of imaging without contrast, the average was $1,416 at hospitals and $387 at offices.
• Location matters. A Peterson-KFF analysis of 2018 large employer claims found an average price of $861 for a lower back MRI. Average prices ranged from $404 in the Las Vegas area to $1,106 in the Houston area.

What you owe depends on your deductible, coinsurance, and network. Our guide on how much an MRI costs shows how to find your price before the scan.

What goes wrong most often

Most imaging bill problems fall into a few groups. Each one has a fix.

• No prior authorization. Your plan needed to approve the scan first, and nobody asked, or the approval didn't match the scan you got. See prior authorization denied.
• A medical necessity denial. Your plan says the scan wasn't needed yet, often because it wants you to try another treatment first. See insurance didn't pay my medical bill.
• An out-of-network radiologist. The hospital is in your network, but the group that read your scan isn't. See does the No Surprises Act apply to my bill.
• A screening billed as diagnostic. A routine screening mammogram or lung scan was coded as a test for a problem, so cost sharing applied. See preventive care billed as diagnostic.
• Hospital prices and facility fees. A scan at a hospital-owned site may bring a facility fee you didn't expect. See facility fees on a medical bill.
• The same part billed twice. A scan, a contrast dye, or a reading appears 2 times. See duplicate charges on a medical bill.

Prior authorization for MRI, CT, and PET scans

Prior authorization is your plan's decision that a service is medically necessary. Plans may require it before certain care, except in an emergency. Approval isn't a promise to pay, but missing it is a common reason for a denial.

Advanced imaging is one of the most common things that needs approval. For example, UnitedHealthcare's 2026 program for most of its employer and Marketplace plans covers CT, MRI, PET, and some heart scans. Scans done in the emergency room, urgent care, observation, or a hospital stay aren't part of that program. Rules differ by plan, so check yours.

Under that program, the office that orders the scan must get approval before scheduling it. If an in-network provider skips that step, the plan may deny the claim, and the provider can't bill you for it. Your plan may have a similar rule. If you get a bill for a scan denied for missing approval, ask your plan whether you owe anything at all.

If your MRI or CT scan was denied

Your plan must tell you why it said no and how to appeal. Here's the usual order.

1. Read the reason. Look for the reason code on your EOB or denial letter. Our guide to denial codes on your EOB explains common ones.
2. Call the ordering office. Ask whether it requested approval, and whether it can fix the request or send more notes. Many denials end here.
3. Ask for a peer-to-peer review. Some plans let your doctor talk with the plan's reviewer before or after a denial. Ask your doctor's office.
4. File an internal appeal. You have 180 days from the denial notice. Your plan must decide within 30 days if you haven't had the scan, or 60 days if you have. Urgent cases are faster.
5. Ask for external review. If your plan still says no, you can usually ask an independent reviewer within 4 months. The plan must accept the decision.

Our prior authorization appeal letter and insurance appeal letter give you the words. See internal appeal vs. external review for more on each step.

Your protections

Several federal rules help with imaging bills. Which ones apply depends on your coverage.

If you have private health insurance, the No Surprises Act has protected you since January 1, 2022. For care at an in-network hospital, hospital outpatient department, or ambulatory surgical center, out-of-network providers can't bill you more than your in-network share. Radiologists and providers of diagnostic services can never ask you to give up this protection. The law also covers scans you get during emergency care.

The law has a gap that matters for imaging. A stand-alone imaging center isn't on its list of covered facilities. So for a planned scan there, the center and its radiologists usually aren't covered by these protections. Check both before you go.

Preventive scans are covered differently. Most private plans cover certain screening tests with no copay or coinsurance from in-network providers, even before you meet your deductible. That includes screening mammograms every 1 to 2 years from age 40. It also includes lung cancer screening for adults 50 to 80 at high risk because of heavy smoking. Federal guidelines for women's preventive care also say that follow-up imaging needed to complete a breast cancer screening is part of the screening. Ask your plan how it covers that follow-up.

If you have Medicare, Part B covers diagnostic scans like CT, MRI, and PET when your provider orders them. At a doctor's office or independent testing facility, you pay 20% of the Medicare-approved amount after the Part B deductible, which is $283 in 2026. At a hospital outpatient department, your copayment may be more than 20%. In most cases, it can't be more than the Part A hospital deductible, which is $1,736 in 2026. Medicare covers a screening mammogram once every 12 months at no cost if the provider accepts assignment.

For CT, MRI, PET, and nuclear medicine scans outside a hospital, Medicare pays only if the provider is accredited. Ask before you go.

If you're uninsured or paying yourself, you have a right to a good faith estimate. You get one when you schedule a scan at least 3 business days ahead, or when you ask. If the bill is $400 or more above the estimate, you can dispute it. You must start within 120 days of the first bill. See good faith estimate disputes.

State rules may add more protections. Your state insurance department can tell you what applies where you live.

How to check your bills

Gather every bill and EOB for the scan. Then work through these steps.

1. List every bill. Note which ones came from the facility, the radiologist, and your doctor. Note any EOB without a bill, and any bill without an EOB.
2. Match each bill to its EOB. Check the name, date, and provider. Our guide to comparing your medical bill vs. EOB shows how.
3. Look at the modifiers. A -TC line and a -26 line for the same scan are normal. 2 global lines, or a global line plus a -26 line, are worth asking about.
4. Check network status. If an out-of-network radiologist read a scan at an in-network hospital, your EOB should show in-network cost sharing.
5. Check for denials. If your plan denied the scan, find the reason before you pay. A missing approval may not be yours to pay.
6. Check screenings. If the scan was a routine screening, make sure it wasn't billed as diagnostic.
7. Ask for an itemized bill. If a bill shows only a total, ask for a list of every charge with its code. See how to get an itemized bill.

Say Priya has a knee MRI at an in-network hospital outpatient department. She has $300 left on her deductible and 20% coinsurance after that. The radiology group that reads the scan is out-of-network.

Bill	Charge	Amount used for her share	Plan paid	EOB says she owes	Bill asks for
Hospital (technical part, -TC)	$3,000	$1,200	$720	$480	$480
Radiologist (professional part, -26)	$450	$150	$120	$30	$330
Total				$510	$810

Here's her share of the hospital claim: the $300 left on her deductible, plus 20% of the remaining $900, which is $180. That's $480.

The radiology group billed her its full charge minus the plan's payment: $450 − $120 = $330. Because the scan was at an in-network hospital, the No Surprises Act limits her to her in-network share of $30. The $300 difference is a balance bill.

Priya pays the hospital $480. She calls the radiology group, gives the claim number, and asks for a corrected bill of $30.

If a call doesn't fix a bill, put your request in writing. Our surprise bill dispute letter covers out-of-network bills like this one. For other errors, see how to dispute a medical bill.

How to avoid a surprise next time

For a planned scan, a few calls before you go can prevent most of these problems.

• Confirm prior authorization. Ask the ordering office whether your plan needs to approve the scan. Then call your plan to confirm it's approved for the right scan and the right place. Write down the reference number.
• Compare places. Ask whether you can safely get the scan at a stand-alone imaging center or office instead of a hospital. Use your insurer's cost estimator to compare your share.
• Check every network. Confirm the facility and the radiology group that reads its scans. Our checklist on how to check if a doctor is in network shows how to keep proof.
• Ask how a screening will be coded. If it's a routine screening, ask the office to order and code it that way.
• Ask for a price. If you're paying yourself, ask for a good faith estimate and the cash price. Our guide to hospital price transparency shows how to look up a hospital's prices.

Our guide on how to avoid surprise medical bills covers each step in more detail.

When to get help

You can fix many imaging bill problems with a few calls. It's worth getting help when:

• Your plan denied a scan you still need, and your doctor's office can't get it approved.
• An out-of-network radiologist won't correct a bill the No Surprises Act should limit.
• A provider bills you for a scan your plan denied for missing approval.
• You're managing bills for someone else, or a bill is already in collections.

Start with your insurer's member services team. The number is on your insurance card. For surprise bills, the federal No Surprises Help Desk answers questions and takes complaints at 1-800-985-3059. Your state insurance department or consumer assistance program can help with appeals.

If you have a serious illness, Patient Advocate Foundation, a nonprofit, offers free case management that can include appeals. A medical bill advocate can also make the calls for you. For a large bill or a lawsuit, an attorney can explain your options.

If your bills are correct but more than you can pay, ask about hospital charity care or medical payment plans.