How Often Will Medicare Pay for an Echocardiogram?

If you need an echocardiogram, you might be asking, “how often will Medicare pay for an echocardiogram?” Our guide explains Medicare’s coverage for this test, focusing on the criteria for medical necessity and the absence of yearly limits, offering peace of mind for those managing heart health with Medicare’s support.


Key Takeaways

  • Medicare covers echocardiograms when deemed medically necessary, without a specific limit on the number per year, but documentation must support the necessity.


  • Medicare Part B provides 80% coverage for outpatient echocardiograms after the annual deductible is met, with patients responsible for the remaining 20% of the approved amount.


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Medicare Coverage for Echocardiograms

Medicare, a significant player in the U.S. healthcare system, does indeed cover an echocardiogram when they are determined to be medically necessary by a healthcare provider. An echocardiogram is a medical imaging test. It uses sound waves to create live images of the heart.

This test provides valuable insights about the heart’s ability to pump blood, helping to identify potential heart conditions such as coronary artery disease or heart valve disease in their early stages.

However, Medicare coverage isn’t just a carte blanche. There are specific circumstances and criteria that must be met for Medicare cover.


Types of Echocardiograms

Medical Necessity

For Medicare to cover the cost of an echocardiogram, the following criteria must be met:


  • The procedure must be ordered by a doctor
  • The procedure must be deemed medically essential
  • Medicare bases its decision on the assessment of the treating physician
  • The healthcare provider must accept Medicare assignment.


A physician may request an echocardiogram to diagnose various heart conditions, such as blood clots, or to assess the heart’s pumping function. Bear in mind that Medicare has the right to deny coverage for an echocardiogram if it’s not considered medically necessary.

Therefore, the patient’s medical record must provide documentation that the coverage criteria have been satisfied for Medicare to pay for the procedure.


Frequency Limitations

There’s no specific limit imposed by Medicare on the number of echocardiograms covered per year, provided they are considered medically necessary. If an echocardiogram is prescribed during a hospital stay (inpatient setting) or at a skilled nursing facility, it falls under Medicare Part A. If it is conducted as an outpatient test, it is covered by Medicare Part B.

The determination of the medical necessity for frequent echocardiograms under Medicare involves evaluating whether there is a suitable utilization of TTE, including stress echocardiography, and the presence of specific ICD-10-CM codes that justify the medical necessity for the procedure. Make sure the provider accepts Medicare assignment.

Types of Echocardiograms

There are two main types of echocardiograms. These are transthoracic and transesophageal. These classifications can help diagnose heart conditions such as heart valve disease.

Echocardiograms generate images that enable physicians to observe the heart’s structure and function, including the effectiveness of blood pumping, the status of the heart valves, and the motion of the heart’s chambers.


Does medicare cover stress test



An EKG, on the other hand, is used to detect irregularities in the heart’s electrical activity by means of electrodes.

It primarily evaluates the heart’s rhythm and electrical conduction. While an EKG reveals valuable information about the heart’s electrical activities, an echocardiogram offers a comprehensive assessment of heart function and structural issues using ultrasound for heart visualization. Medicare will pay for both tests if they are deemed medically necessary.


Medicare Part B Coverage

Medicare Part B covers 80% of the expenses related to outpatient echocardiograms, once the annual deductible has been met. When this deductible is met, the patient becomes accountable for 20% of the Medicare-approved amount for an echocardiogram.

The Medicare-approved amount refers to the maximum charge that a healthcare provider can bill for a specific service. In the case of echocardiograms, patients generally cover 20% of this approved amount once they have met the Medicare Part B deductible.

Medicare Advantage Plans

Medicare Advantage plans, provided by private insurance companies, offer an alternative to original Medicare.


Average cost of echocardiogram with insurance



These Medicare Advantage plans cover all aspects of Original Medicare (Part A and Part B), including echocardiograms in an inpatient or outpatient setting. Individual plans, however, may have different rules, costs, and limitations, so it’s necessary to consult with your plan provider to comprehend the specifics of your echocardiogram coverage.

Original Medicare and Medicare Advantage plans both offer coverage for echocardiograms, which means medicare cover an echocardiogram. The out-of-pocket costs can vary, though, based on the Medicare Advantage Plan. Factors like plan deductibles, copayments, and coinsurance rates influence the total cost borne by the beneficiary.

Not all Medicare Advantage Plans provide identical coverage for echocardiograms. Each plan may have its specific terms for the coverage of echocardiograms.

Medicare covers echocardiograms when they are medically necessary, and Medicare Advantage plans do the same. However, the specifics related to pre-authorizations, network restrictions, and provider choices may vary from one plan to another.

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Reducing Out-of-Pocket Expenses

Medicare Supplement plans, also known as Medigap, can help lower out-of-pocket expenses for echocardiograms by covering some or all of the remaining 20% that Medicare Part B does not cover, thus making sure Medicare pays for a larger portion of the cost.

There exist 10 distinct categories of Medicare Supplement plans, denoted by letters A-D, F, G, and K-N. The coverage for echocardiograms may differ across these plans, but all are designed to supplement Medicare coverage.


Additional Heart Tests and Medicare Coverage

Medicare provides coverage for supplementary heart examinations, including:


  • EKGs
  • Stress tests
  • Blood tests
  • Chest x-rays
  • Other tests


These tests are covered when they are considered medically necessary by a healthcare provider.

Medicare covers specific heart tests such as:


  • A cardiac CT scan, which is a specialized X-ray used to obtain detailed heart images
  • Cardiac catheterization, an invasive procedure utilized for diagnosing or treating heart conditions
  • Nuclear heart scans that assess blood flow and reveal the heart’s condition using a small amount of radioactive substance
  • Stress tests that measure heart performance under exercise-induced stress
  • Holter monitors, which record the heart’s electrical activity over extended periods

These tests are all included in Medicare’s coverage.


How much does an echocardiogram cost with blue cross blue shield



Medicare will provide coverage for the cost of these additional heart tests if a healthcare provider deems them medically necessary for the diagnosis, treatment, or management of a heart-related issue.

And yes, Medicare Part B does cover the expenses associated with heart monitoring devices such as Holter monitors, event monitors, or loop recorders, given that they are essential for the diagnosis or management of heart conditions.

Monitoring Your Heart Health

Regular monitoring is vital in the early detection of heart problems, which leads to more effective treatment. It also helps in identifying modifiable risk factors to lower the risk of heart disease. Collaborating with a healthcare provider for regular monitoring can ensure that you receive the necessary Medicare-covered tests and treatments.


How much does an echocardiogram cost without insurance



Typical indications that should prompt regular monitoring of heart health comprise:


  • Chest pain
  • Fainting
  • Fatigue
  • Irregular heartbeat
  • Shortness of breath
  • Swollen feet or ankles

If deemed medically necessary, medicare pay for these tests will be provided.


Generally, it’s advised for adults to have a heart health checkup annually as a part of their routine medical examinations with a healthcare professional. Medicare covers these checkups if they are deemed medically necessary.


We’ve navigated the complexities of Medicare and its coverage for echocardiograms and other heart tests. It is clear that Medicare plays a crucial role in supporting beneficiaries in maintaining their heart health, covering a wide range of tests when they are medically necessary.

However, it is important to understand that coverage can vary based on the specifics of each patient’s case, the type of Medicare plan, and whether the healthcare provider accepts Medicare assignment.

Remember, your heart health is not something to gamble with. Regular monitoring, early detection, and treatment of potential heart issues can make a stark difference in outcomes. So, collaborate with your healthcare provider and ensure you understand your Medicare coverage to take full advantage of these life-saving tests.

Frequently Asked Questions



Does Medicare pay for an echocardiogram?

Yes, Medicare covers echocardiograms if they are deemed medically necessary and if the healthcare provider accepts Medicare assignment. However, there may be out-of-pocket costs involved for the individual, regardless of whether they have original Medicare or Medicare Advantage.


How often should you have an echocardiogram?

You should have an echocardiogram every 6 to 12 months or more frequently if closer monitoring is necessary for an existing heart condition. Schedule regular check-ups to monitor your heart health effectively.


→  Does Medicare cover a yearly ECG?

Yes, Medicare covers a yearly ECG, with Part B providing coverage at 80% and the patient responsible for the remaining 20% after meeting the deductible.


How much does an echocardiogram cost out-of-pocket?

The cost of an echocardiogram can range from $1000 to over $3000, depending on factors such as location and the facility providing the procedure. Booking through Sesame can help you find the best price for an imaging appointment near you.


What types of echocardiograms does Medicare cover?

Medicare covers two main types of echocardiograms: transthoracic and transesophageal. You can learn more about the coverage by contacting Medicare directly.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.