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Does Medicare Cover an Echocardiogram


Original Medicare covers echocardiogram costs when it is medically necessary. Your doctor may order an echocardiogram to measure how well your heart pumps blood throughout your body.

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In addition to an echocardiogram, Medicare will cover other medically necessary heart tests to help your doctor diagnose or check the progression of a heart-related issue. Below, we review guidelines, coverage, and common questions relating to Medicare coverage for echocardiograms and other heart-related tests.

What is an Echocardiogram?

An echocardiogram is a heart test that uses sound waves to create internal images of your heart. This standard test allows your medical provider to view your heart beating and pumping blood throughout your body.

There are two main types of echocardiograms. The type of echocardiogram you receive depends on the images your provider needs.

A transthoracic echocardiogram is the most common type. This test involves a sonographer using a device like an ultrasound machine to record live images of your heart and its valves.

A transesophageal echocardiogram involves a local anesthetic in your throat. Your provider will introduce a flexing tube down your esophagus to your stomach. This device then records images of your heart to an external monitor that your provider will view.

An echocardiogram creates images that allow your doctor to view or diagnose heart disease.

Does Medicare Cover a Routine Echocardiogram?

Medicare will only cover an echocardiogram when a practitioner deems it medically necessary. Echocardiograms are not part of your Medicare annual wellness visit and are not a preventative service. However, if your doctor requires you to have an echocardiogram due to a heart issue, you will receive Medicare coverage.

Echocardiogram vs EKG

An EKG or an electrocardiogram is a test that searches for abnormalities in your heart’s pulses through electrodes. Although the names are similar, an electrocardiogram (EKG) differs from an echocardiogram. Both are considered non-invasive cardiac testing. However, the results shown from the tests are different.
The chart below shows the differences between an echocardiogram and an EKG.

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  Echocardiogram Electrocardiogram (EKG)
How is the test performed? Similar to an ultrasound, a gel is applied to your chest area, and a probe transmits sound waves to your heart, capturing internal images Ten small sticker pads are placed around your chest and attached to the EKG machine. The pads transmit a wave that records the electrical activity of your heart
How long does the test take? 20 minutes on average 5 minutes on average
What information does the test provide? How well your heart is pumping blood throughout your body and the size of your heart chambers Your heart rate and rhythm. It is used to detect heart rhythm disorders, abnormal heart rates, and irregular heartbeats

Does Medicare pay for a routine EKG?

Medicare will only pay for one screening EKG in your lifetime. To be covered, your doctor must order the EKG as part of your Welcome to Medicare visit.

Your doctor may perform your Welcome to Medicare EKG at the office or send you to an outpatient facility. Either way, Medicare Part B will pay a portion of the Medicare-approved rate for the procedure.

You must attend your Welcome to Medicare visit within the first 12 months you are on Medicare. Otherwise, Medicare will not pay for a routine EKG. To receive Medicare coverage for an EKG outside your Welcome to Medicare visit, your physician must deem the test medically necessary. 

Medicare Guidelines for a Diagnostic Echocardiogram and EKG

Medicare Part B will pay for unlimited outpatient diagnostic echocardiograms and EKGs. However, for Medicare to categorize the test as diagnostic, it must be medically necessary. Once you meet your Medicare Part B deductible, you will be responsible for 20% of your EKG or echocardiogram cost.

You may need an echocardiogram or EKG if you experience any of the following:

  • Severe dizziness or lightheadedness
  • Chest pain and/or shortness of breath
  • Symptoms that could indicate heart disease, and your doctor wants to confirm or rule out heart problems
  • You have heart disease, and your doctor wants to monitor your condition
  • Your doctor orders an echocardiogram or EKG before you undergo surgery

An echocardiogram or EKG may diagnose:

Additionally, to receive Medicare coverage for an echocardiogram or EKG, you must receive care from a provider who accepts Medicare.

How to Lower Your Medicare Costs for an Echocardiogram

Additional Medicare coverage is essential for lowering your out-of-pocket medical costs. A Medicare Supplement plan may be your best option for keeping your expenses low over time.

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A Medicare Supplement plan covers the out-of-pocket expenses for which you may otherwise be responsible. Therefore, these policies significantly reduce the total you owe for services.

Additionally, when you enroll in a Medicare Supplement plan, you do not need to worry about networks. If a provider accepts Original Medicare, they will also take your Medicare Supplement plan as payment, regardless of your carrier.

If a Medicare Supplement plan is not for you, a Medicare Advantage plan may be the best option. Medicare Advantage plans must cover the same services as Original Medicare.

However, the private insurance companies offering Medicare Advantage policies set the deductibles, copays, and coinsurance. So, you could end up paying more for your test than you would with a Medicare Supplement plan.

Additionally, to avoid unexpected bills, ensure the doctors administering your EKG are in your Medicare Advantage plan’s network. Either way, a Medicare Supplement or Medicare Advantage policy will cap your out-of-pocket costs, unlike Original Medicare. Thus, leaving you with fewer overall out-of-pocket costs.

Additional Heart Tests Covered by Medicare

In addition to echocardiograms and EKGs, Medicare will cover a variety of other heart tests to ensure your heart’s health. These tests include:

  • Holter monitors
  • Heart monitors
  • Stress test
  • Chest x-ray
  • Coronary angiography
  • Cardiac CT scan
  • Cardiac catheterization

If your doctor deems any of the above tests medically necessary to diagnose, treat, or manage a heart-related issue, Medicare will cover their portion of the costs.

Medicare Coverage for Echocardiograms FAQs

How much does an electrocardiogram cost?
The average cost of an EKG is $205. However, this cost can range based on the doctor and the type of facility where you receive the test. After you meet the Part B deductible, Original Medicare will cover 80% of the total cost of your EKG, and you will pay the remaining 20% unless you have a Medicare Supplement plan, which picks up the balance.
Does Medicare cover heart scans?
Medicare Part B covers tests to diagnose and monitor heart disease. These tests include heart scans.
Does Medicare cover a pre-op EKG?
Medicare covers pre-operative tests, including EKGs, if they are medically necessary. Medicare Part B covers tests performed as an outpatient, while Medicare Part A will pay for an EKG while you are a hospital inpatient.
Does Medicare cover a Holter monitor?
A Holter monitor is a wearable device that tracks your heartbeat over at least 24 hours. The monitor is used to diagnose abnormal heart rhythms or arrhythmias. Medicare Part B covers testing with a Holter monitor if it is necessary.

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How to Get Help Managing a Heart Condition with Medicare

If you develop a heart condition, your doctor will want to monitor your health, and you may need heart procedures in the future. Consequentially, this may mean several EKGs or echocardiograms. Medicare covers some of your costs, but caring for a heart condition can be costly.

A Medicare Supplement plan helps you avoid financial risk by paying all or part of the bill that Medicare leaves behind after paying your monthly premium. These policies leave you with little to no out-of-pocket costs.

At MedicareFAQ, we help you find the right Medicare Supplement plan for your healthcare needs and budget by performing a needs analysis and comparing all the top plans in your area. Call the number above or complete our online rate form for your free plan comparison today!

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Sources:

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Electrocardiogram (EKG or ECG) screenings, Medicare. Accessed September 2022.
    https://www.medicare.gov/coverage/electrocardiogram-ekg-or-ecg-screenings
  2. Transthoracic Echocardiography (TTE), CMS . Accessed September 2022.
    https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=34338&ver=26

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

2 thoughts on “Does Medicare Cover an Echocardiogram

  1. I had a coronary artery bypass graph procedure in 2017 and was subsequently diagnosed with pericarditis. My most recent echo cardiogram was in March 2021, which showed mild aortic stenosis not present in the previous echo. My question is, will Medicare pay for an echo performed in February 2020 or do I have to wait until March, that is, a year and a day after the previous echo. Thank you.

    1. Hi Kevin! If the echocardiogram is medically necessary, Medicare will cover it. You don’t need to wait for the full 12-months. That rule only counts the first 12-months you are enrolled in Medicare, during this time frame it’s considered routine. After your initial 12-months, Medicare will only cover it if it’s medically necessary. Therefore, if your doctor says it’s medically necessary now, Medicare will cover it again.

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