Medicare Denied Your MRI Scan?
Centers for Medicare & Medicaid Services (CMS) denies 18% of claims on average. But 75% of appeals succeed when patients fight back. Your mri scan denial may have grounds for a successful appeal.
Why Medicare Denies MRI Scan
Prior authorization required but not obtained
Deemed not medically necessary at this stage
Lower-cost imaging (X-ray, CT) not tried 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 MRI Scan Appeal
Clinical notes explaining why MRI is specifically needed over other imaging
Documentation of symptoms warranting urgent imaging
Peer-to-peer review between ordering physician and insurer medical director
Laws That Protect You
ACA §2719 — Right to appeal imaging denials
No Surprises Act — Protection against balance billing
State laws requiring timely authorization decisions
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 MRI Scan Denial?
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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.