A computed tomography (CT) scan is a noninvasive medical imaging test that uses a rotating X-ray machine and a computer to create detailed cross-sectional images of the body. These images, often called “slices,” provide greater clarity of internal organs, bones, soft tissues, and blood vessels than a traditional X-ray. Doctors use CT scans for a range of purposes, including diagnosing injuries, planning surgeries, locating tumors or infections, and monitoring the effectiveness of certain treatments. Understanding the steps required to access this procedure is the first move in getting the necessary diagnostic care.
Securing the Necessary Referral
Getting a CT scan begins with a formal order from a treating physician who determines its medical necessity. This physician’s order is a regulatory requirement that validates the need for the procedure. The order must specify the exact type of scan required, such as a CT of the abdomen or chest, and whether contrast material is needed. Contrast agents, typically iodine- or barium-based, are administered orally or intravenously to enhance the visibility of structures like blood vessels or soft tissues.
Following the physician’s order, the next administrative hurdle is often insurance pre-authorization. Most commercial and government plans require this step for high-modality imaging tests like CT scans, MRIs, and PET scans. The referring doctor’s office staff usually initiates this process by submitting clinical documentation to your insurer to demonstrate why the scan is medically warranted.
The pre-authorization process can take time, sometimes ranging from a few days to a couple of weeks, depending on the complexity of the case and the insurance provider’s workflow. If authorization is not secured, the insurance company may not cover the cost, leaving you responsible for the entire bill. It is important to wait for confirmation of approval before scheduling your appointment, though the imaging center may also assist in following up on the authorization status.
Different Types of Imaging Facilities
Once the proper authorization is in place, you can choose where to have the scan performed, which typically falls into one of three main categories. Hospital imaging departments are suitable for emergency or complex cases because they have specialized equipment and staff available around the clock. However, these facilities generally have higher operating costs, which translates into a higher price for the scan.
Freestanding outpatient imaging centers focus solely on diagnostic services outside of a hospital setting. These centers often offer a more streamlined experience with easier scheduling for routine, non-emergency appointments. Due to lower overhead, the price for a CT scan at an outpatient center is often significantly lower than the same procedure performed at a hospital.
A third option includes specialized clinics or high-volume urgent care centers. These facilities may offer CT services for localized scans, such as an extremity scan, but they may not be equipped for complex scans requiring specialized contrast administration. When selecting a facility, check for accreditation. Accreditation, such as that provided by the American College of Radiology (ACR), signifies adherence to high standards of image quality and safety.
Understanding Costs and Insurance Coverage
The final price you pay is heavily influenced by the type of facility, with hospital-based scans often costing substantially more than those performed at outpatient centers. This price difference exists even before insurance adjustments are applied.
Your insurance coverage determines your out-of-pocket responsibility, which typically involves the deductible, co-pay, and co-insurance. The deductible is the amount you must pay annually before your insurance begins to cover costs. After the deductible is met, you may owe a co-pay (a fixed fee) or co-insurance (a percentage of the total allowed charge).
Contact your insurance provider directly to confirm expected coverage and any remaining deductible amount before your appointment. For patients without insurance or those with high-deductible plans, negotiating a self-pay or cash price with the imaging facility is often possible. Many facilities offer a substantial discount, sometimes 30% to 50% lower than the billed price, for patients who pay in full at the time of service.