Heart health is one of the most important aspects of our health. So if there is something wrong with our cardiovascular health, it could lead to a severe condition. A nuclear stress test examines the blood flow from and to the heart. This test allows doctors to know if there is something wrong with your heart or not. 

If this is a test your doctor has recommended for you, a common question many people have is, “does Medicare cover a nuclear stress test?” In this article, we answer that question in clear, plain English. You will also find the average costs of nuclear stress screening if you have to pay for it out of pocket.

Does Medicare Cover a Nuclear Stress Test?

The short answer is yes; Medicare will cover the cost of your nuclear stress test. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your nuclear stress test. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for nuclear stress screening. Parts A and/or B provide coverage for your nuclear stress screening if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

Coverage for nuclear stress tests is provided by Medicare Part A if it takes place in an inpatient setting such as a hospital or a skilled nursing facility. 

Most of the time, coverage for nuclear screening tests is provided by Medicare Part B. Medicare Part B often covers 100 percent of the costs of medically necessary laboratory tests, including nuclear stress screenings.

Part C Coverage for Nuclear Stress Test

Medicare Advantage plans (Medicare Part C) also provide coverage for nuclear stress screenings. These plans have to cover all the tests, treatments, services, etc. that Original Medicare covers. They will also cover things that Original Medicare does not. However, exactly what is covered as well as how much the cost for that coverage is will vary from plan to plan.  

Coverage for Treatment of Cardiovascular Condition

If you are diagnosed with a heart or cardiovascular condition after the tests, Original Medicare will provide coverage for the treatment. 

Coverage for cardiovascular disease treatment is provided by Medicare Part A if your cardiovascular disease takes place in an inpatient setting. On the other hand, coverage for cardiovascular disease treatment is provided by Medicare Part B as it often takes place in an outpatient setting.

Medicare Advantage plans (Medicare Part C) also provide coverage for cardiovascular disease treatment. Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you.

Medicare Part D plans provide coverage for medications that you need for treating cardiovascular disease. Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Does A Nuclear Stress Test Cost?

The average cost of a nuclear stress test, along with the analysis, ranges from $1,00 to $5,000 if you don’t have insurance coverage. This cost will vary depending on the provider.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover glaucoma surgery?

Leave a Reply