Skip to main content
Imaging Denial

Medicare Denied Your CT Scan?

According to federal data, Centers for Medicare & Medicaid Services (CMS) denies approximately 18% of claims. When patients appeal, about 75% are overturned. Your ct scan denial may have grounds for a successful appeal.Sources: KFF ACA Marketplace Transparency Data, HHS OIG Reports, state insurance department filings. Rates are aggregate averages — individual results vary by plan type, denial reason, and documentation.

18%
Denial Rate
75%
Appeal Success
60-90 days
Typical Timeline
$1,000–$5,000
Typical Claim

Based on published government and industry research. Individual results vary based on denial type, insurer, and documentation.

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 Review Your CT Scan Denial?

Upload your denial letter and get a clear analysis in minutes. We'll identify potential weaknesses in Medicare's reasoning and outline your appeal options.

Analyze My Denial Free

Analysis is always free. No credit card required.

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.

Medicare Denied Your CT Scan? Here's How to Appeal | Lysco