Medicare Denied Your CT Scan?
Centers for Medicare & Medicaid Services (CMS) denies 18% of claims on average. But 75% of appeals succeed when patients fight back. Your ct scan denial may have grounds for a successful appeal.
Why Medicare Denies CT Scan
Not medically necessary based on clinical criteria
MRI recommended instead of CT
Prior imaging not attempted first
Medicare's Common Denial Tactics
Denying claims as not reasonable and necessary
Coverage determinations based on LCD/NCD criteria
Denying skilled nursing facility stays as custodial care
How to Win Your CT Scan Appeal
Physician order with clinical indication
Evidence that CT is more appropriate than MRI for the condition
ACR Appropriateness Criteria supporting CT for diagnosis
Laws That Protect You
ACA — Preventive screening requirements
State imaging parity laws
Emergency prudent layperson standard
Tips for Appealing to Medicare
Medicare has a 5-level appeal process — most denials are overturned by level 2 or 3
Request an ALJ hearing if redetermination and reconsideration fail
Cite specific LCD/NCD criteria and explain how your case meets them
Ready to Fight Your CT Scan Denial?
Upload your denial letter and get an AI-powered analysis in minutes. We'll identify the weaknesses in Medicare's reasoning and build your appeal strategy.
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This information is for educational and informational purposes only. It does not constitute legal or medical advice. Statistics cited are from publicly available sources including KFF, HHS OIG, and state insurance department data. Individual results may vary. Consult a qualified professional before taking action on your specific situation.