Medicare covers echocardiograms when your doctor orders one to diagnose or monitor a heart condition

Medicare Part B covers the cost of an echocardiogram if your doctor believes you have a heart problem that needs imaging to diagnose or track. You pay 20 percent of the approved amount after you meet your Part B deductible for the year. The facility where you have the test — whether a hospital, imaging center, or doctor's office — must be enrolled in Medicare for the coverage to explore.

An echocardiogram is an ultrasound of your heart. It shows how well your heart is pumping, whether the valves are working properly, and whether there are any structural problems. Your doctor might order one if you have chest pain, shortness of breath, a heart murmur, or a history of heart disease. The test itself takes 20 to 40 minutes and is painless.

Key Takeaways

  • Medicare Part B covers echocardiograms ordered by your doctor to diagnose or monitor heart conditions, and you pay 20 percent of the approved cost after your deductible.
  • The facility performing the test must be enrolled in Medicare, so confirm this before your appointment to avoid unexpected bills.
  • Medicare does not cover echocardiograms done for screening purposes if you have no symptoms or known heart condition.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower than the standard 20 percent.

When Medicare will and will not cover the test

Medicare covers an echocardiogram when your doctor orders it because you have signs or symptoms of heart disease, or because you have a known condition that needs monitoring. This includes situations where you have chest pain, shortness of breath, a previous heart attack, valve disease, heart failure, or an irregular heartbeat. It also covers follow-up echocardiograms to track how well a condition is being managed or how you are responding to treatment.

Medicare does not cover an echocardiogram done purely for screening — that is, to check your heart health when you have no symptoms and no known heart condition. If your doctor orders the test for screening reasons, you will be responsible for the full cost. Some Medicare Advantage plans may cover screening echocardiograms as an added benefit, so check your plan documents if you are unsure.

What you will pay out of pocket

Under Original Medicare, you pay 20 percent of the Medicare-approved amount for the echocardiogram after you have met your Part B deductible for the year. The deductible is set each year by Medicare and changes annually. Once you reach it, you continue to pay 20 percent for any other Part B services for the rest of the year.

The actual cost varies depending on where you have the test done and your geographic location. A hospital-based echocardiogram typically costs more than one done in an outpatient imaging center. Before your appointment, ask the facility what the Medicare-approved amount is for the test so you can estimate your 20 percent share. If you have a Medigap policy, it may cover some or all of that 20 percent. If you have a Medicare Advantage plan, your copay or coinsurance will depend on your specific plan.

How to make sure the facility is Medicare-enrolled

Before you schedule your echocardiogram, confirm that the facility is enrolled in Medicare. You can search for this information on the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) at pecos.cms.hhs.gov, or you can call Medicare at 1-800-MEDICARE (1-800-633-4227) and ask whether a specific facility is enrolled.

If you go to a facility that is not enrolled in Medicare, Medicare will not pay its share, and you may be billed for the entire cost. Some non-enrolled facilities will still perform the test and bill you directly. Always verify enrollment before your appointment to avoid this surprise.

Echocardiograms ordered during a hospital stay

If you have an echocardiogram while you are an inpatient in a hospital (admitted for at least one night), the cost is covered under Medicare Part A, not Part B. You pay your Part A inpatient deductible and coinsurance, which depend on the length of your stay. The echocardiogram itself is bundled into your hospital bill and is not billed separately.

If you have an echocardiogram in a hospital outpatient department — meaning you go to the hospital for the test but are not admitted — it is covered under Part B, and you pay the 20 percent coinsurance after your deductible.

Stress echocardiograms and other variations

A stress echocardiogram, where your heart is imaged while you exercise or take medication to raise your heart rate, is also covered by Medicare Part B when your doctor orders it to diagnose or monitor a heart condition. You pay the same 20 percent coinsurance. A transesophageal echocardiogram (TEE), where the ultrasound probe is passed down your throat to get a closer look at the heart, is also covered under the same rules.

Three-dimensional echocardiograms and other advanced imaging techniques are covered if your doctor determines they are medically necessary for your diagnosis or treatment. The coverage and your out-of-pocket cost remain the same.

What to do if you receive an unexpected bill

If you receive a bill for an echocardiogram that you believe Medicare should have covered, first check that the facility was Medicare-enrolled at the time of your test. You can verify this through PECOS or by calling Medicare. If the facility was enrolled and you were billed anyway, contact the facility's billing department and ask them to resubmit the claim to Medicare.

If the facility was not enrolled, you may have the right to dispute the bill. Contact Medicare at 1-800-MEDICARE to report the issue and ask about your options. Keep copies of all bills and correspondence. If you believe you were wrongly denied coverage, you can file an appeal with Medicare.

Frequently Asked Questions

Do I need a referral from my doctor to have an echocardiogram covered?

No, you do not need a formal referral. Your doctor straightforward needs to order the test. However, your doctor must document in your medical record that the test is medically necessary — that is, that you have symptoms or a condition that requires it. The imaging facility will verify that the order is from a physician before performing the test.

Will Medicare cover an echocardiogram if I have a Medicare Advantage plan?

Yes, Medicare Advantage plans must cover all services that Original Medicare covers, including echocardiograms ordered for medical reasons. However, your out-of-pocket cost may be different — you might pay a copay instead of 20 percent coinsurance. Check your plan's summary of coverage or call the plan to find out what you will owe.

What if my doctor wants to repeat an echocardiogram soon after my last one?

Medicare will cover a repeat echocardiogram if your doctor documents that it is medically necessary — for example, to check how you are responding to a new medication, or because your condition has changed. Medicare does not cover echocardiograms done too frequently without medical justification, so your doctor will need to explain the clinical reason for the repeat test.

Can I have an echocardiogram at an urgent care or walk-in clinic?

Some urgent care centers and walk-in clinics have ultrasound equipment and can perform echocardiograms, but not all do. If they do, Medicare will cover it the same way — 20 percent coinsurance after your deductible — as long as the facility is Medicare-enrolled. Call ahead to confirm they offer echocardiograms and that they accept Medicare.

What happens if I have not met my Part B deductible yet?

You will pay the full cost of the echocardiogram until you reach your Part B deductible for the year. Once you have paid enough out of pocket to meet the deductible, you then pay 20 percent of the approved amount for any remaining Part B services that year. Ask the facility for an estimate of the approved amount so you know how much will count toward your deductible.