Does Medicare Cover an Echocardiogram?

There are many well-known types of heart tests out there. And one of the most common is a test called an echocardiogram.

This is an imaging test that uses sound waves to measure how your heart is functioning. Though this is an important heart test, it is quite expensive and not everyone who needs one can easily afford it.

So a common question many people have is, “Does Medicare cover an Echocardiogram?” In this article, we answer that question in clear, plain English. You will also find the average costs of echocardiogram tests and other helpful info.

Does Medicare Cover an Echocardiogram?

The short answer is yes; Medicare will cover the cost of an echocardiogram 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 echocardiogram. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) provides coverage for echocardiogram tests. But for Medicare to provide coverage for your echocardiogram test, there are some conditions that must be followed. Those conditions are:

Your healthcare provider must order the echocardiogram test for a medically necessary reason
Your healthcare provider must be Medicare-enrolled

If your healthcare provider accepts Medicare assignment, he/she must accept the Medicare-approved amount of your echocardiogram test.

Part A

Coverage for an echocardiogram test falls under Medicare Part A if the test takes place in an inpatient setting. Medicare Part A will cover all the services and procedures done during an inpatient stay, including an echocardiogram test.

Part B

On the other hand, coverage for an echocardiogram test falls under Medicare Part B if the test takes place in an outpatient setting. Of course, coverage is subject to meeting the requirements above. Most importantly that the test is medically necessary.

Once approved, Medicare Part B will cover 80 percent of the costs of your echocardiogram test.

Part C

Medicare Advantage plans (Medicare Part C) also provide coverage for an echocardiogram test. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and how much the out-of-pocket costs will vary depending on the specifics of your plan.

How Much Does An Echocardiogram Test Cost?

Undergoing an echocardiogram test will usually cost between $1,000 and $3,000. This is for those who do not have insurance.

How Does An Echocardiogram Test Work?

This test uses sound waves that bounce off your heart. It produces a live image of how your heart is functioning. This test can be done for a lot of reasons including:

To see how efficiently your heart contracts and relaxes
To see how well your heart valves are working
If there are any problems with the blood vessels around your heart

It is performed while you are lying on your back or your side, depending on what kind of photos need to be taken.

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.