Medicare patients getting X-rays, CT scans, MRIs and bone-density tests at off-campus hospital departments are set to pay about $70 million less in cost-sharing in 2027, according to estimates in the final outpatient payment rule the Centers for Medicare & Medicaid Services issued on Nov. 4. The saving comes from paying those departments the same rate Medicare pays under the physician fee schedule. Patients owe a share of the payment, so a smaller payment means a smaller bill.
The $70 million is a first-year total across all patients, not a per-person amount. CMS has not published a dollar figure per scan, so a single patient’s saving depends on the test, the hospital and the Medicare-approved amount. The policy covers calendar year 2027.
Which scans and which clinics are covered
The rule applies to what CMS calls imaging without contrast services, which it says include certain bone density scans, X-rays, ultrasounds, CT scans and MRIs. The fact sheet does not publish a full list of billing codes. Scans done with contrast are not part of the policy as CMS describes it.
The setting matters as much as the scan. The policy covers off-campus provider-based departments, the hospital-owned clinics located away from the main campus that were excepted from section 603 of the Bipartisan Budget Act of 2015. Rural sole community hospitals are exempt from the policy.
Anyone scheduled for a non-contrast scan at a clinic that carries a hospital’s name but sits across town is the patient the rule is aimed at. Before the appointment, a call to the scheduler asking whether the department is hospital-owned and what Medicare-approved amount applies will show which payment rate is in play. That answer is the most direct way to see whether the 2027 rate has reached a given bill.
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How the payment cut reaches the bill
Medicare.gov says that after the Part B deductible, patients pay 20% of the Medicare-approved amount for diagnostic tests in a doctor’s office or independent facility. In a hospital outpatient department, the page adds that the patient also pays the hospital a copayment that may be more than 20% of the Medicare-approved amount. In most cases that amount cannot be more than the Part A hospital stay deductible.
A lower Medicare-approved amount for the scan lowers the 20% figure calculated from it. That is the mechanism behind CMS’s estimate that beneficiary cost-sharing will fall by about $70 million in the first year. CMS says the policy “helps ensure that beneficiaries are not subject to higher premiums and cost sharing based solely on the site at which care is furnished.”
The same scan can therefore cost a patient differently depending on where it is done. Medicare.gov’s outpatient hospital services page notes that the hospital usually charges a separate copayment for each outpatient service and advises patients to ask the doctor or provider how much a test will cost. An independent imaging center is a different payment setting from a hospital department.
The $260 million behind the $70 million
CMS puts a separate figure on what the change does to Medicare Part B as a whole. It estimates total Part B spending falls by about $260 million in the first year, made up of about $190 million in Part B savings and about $70 million in lower beneficiary premiums. The roughly $70 million drop in beneficiary cost-sharing is counted on top of that.
The premium effect is also a group figure. Lower Part B spending feeds into premiums for everyone who pays them, including people who never get a scan at a hospital clinic. For an individual, the premium saving is spread so thinly that it will not show up as a line on a Medicare statement.
The legal basis for the new rate
CMS cites section 1833(t)(2)(F) of the Social Security Act, which gives it a volume control method for outpatient services. Using that authority, it will apply the physician fee schedule equivalent payment rate to the billing codes assigned to the imaging-without-contrast payment groups. In plain terms, the hospital department gets paid the amount a physician-office setting would get.
The off-campus hospital department is the target because the same scan in a physician’s office or independent facility is paid at the lower physician fee schedule rate. Paying both settings the same amount removes the price gap that, in CMS’s words, makes cost sharing higher based solely on site. The agency does not say how many patients or scans the rule will reach, so the $70 million cannot be divided into a typical saving.
The rule is final, but its effect shows up only on claims for 2027 services. Patients with a scan on the calendar in January can ask at the time of booking which department will perform it and what Medicare approves. Those numbers, not the $70 million national total, decide what the bill looks like, and they are worth writing down before the visit.
Due for a scan at a hospital’s off-campus clinic?
One detail decides many scan bills: the hospital copayment can run past the usual 20%, and it is easy to miss on a statement. A $70 million national estimate says little about what one MRI at a hospital clinic will cost a household on a fixed income.
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
