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

An echocardiogram is an ultrasound of your heart that shows how well it is pumping and whether the valves are working properly. Medicare Part B pays for the procedure itself when it is medically necessary — meaning your doctor has documented a reason for it, such as chest pain, shortness of breath, or a known heart problem that needs monitoring.

You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible for the year. The facility where you have the test (a hospital, imaging center, or cardiology office) must be enrolled in Medicare for the coverage to explore. If you go to an out-of-network provider, you may owe more.

The type of echocardiogram matters. A standard transthoracic echocardiogram — the most common kind, done with a probe on your chest — is covered. A transesophageal echocardiogram, which requires a tube down your throat, is also covered when medically necessary. Stress echocardiograms, where you exercise or receive medication while being scanned, are covered under the same rules.

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 meeting your deductible.
  • The facility performing the test must be enrolled in Medicare; if you use an out-of-network provider, your out-of-pocket cost will likely be higher.
  • Routine screening echocardiograms for people without heart symptoms are not covered, but echocardiograms ordered to evaluate specific symptoms or existing conditions are.
  • Your doctor's office can tell you whether Medicare will cover your specific echocardiogram before you schedule it by checking the medical necessity.

When Medicare covers an echocardiogram

Medicare covers an echocardiogram when your doctor has a documented medical reason for ordering it. Common reasons include evaluating chest pain, investigating new heart murmurs, monitoring known valve disease, checking heart function after a heart attack, or assessing symptoms like persistent shortness of breath or fainting.

If you have a history of heart disease and your cardiologist orders an echocardiogram as part of your regular follow-up care, that is covered. If you have atrial fibrillation and your doctor wants to check for blood clots in your heart, that is covered. If you are having symptoms that could point to a heart problem, Medicare will cover the test to help your doctor figure out what is happening.

The key is that your doctor must document the medical reason in your chart before the test is done. The imaging center will verify this with Medicare before you arrive, or your doctor's office will do so when you call to schedule.

When Medicare does not cover an echocardiogram

Medicare does not cover screening echocardiograms for people who have no symptoms and no known heart disease. If you feel fine and your doctor suggests an echocardiogram just to check your heart "to be safe," Medicare will not pay for it. This is true even if you have risk factors like high blood pressure or a family history of heart disease.

Medicare also does not cover echocardiograms ordered for reasons unrelated to heart function — for example, to measure your heart size for a life insurance process, or to satisfy a workplace or sports clearance requirement when there is no medical concern. In those cases, you would pay the full cost out of pocket.

If your doctor is unsure whether your situation meets Medicare's coverage rules, your doctor's office can contact Medicare or check the Local Coverage information (LCD) for your area. LCDs are specific rules that Medicare contractors in your region follow, and they can vary slightly by location.

What you pay for an echocardiogram

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. Once you have paid the deductible (which changes each year), you pay 20 percent of the Medicare-approved amount for the echocardiogram. The facility bills Medicare first, and Medicare tells you what you owe.

The total approved amount varies by location and facility type. A hospital outpatient department may have a different approved amount than a standalone imaging center. Your doctor's office or the imaging center can give you an estimate before your appointment by looking up the code for your specific test in the Medicare fee schedule for your area.

If you have a Medigap policy or Medicare Advantage plan, your coverage may be different. Medigap plans often cover the 20 percent coinsurance, so you may owe nothing. Medicare Advantage plans have their own rules and may require a copay instead of coinsurance. Check your plan documents or call your plan to find out your exact cost before the test.

How to make sure your echocardiogram is covered

Before you schedule an echocardiogram, ask your doctor's office to confirm that Medicare will cover it. The office staff can check your medical record to make sure the reason for the test is documented, and they can verify coverage with Medicare or the imaging center.

When you call to schedule, tell the facility that you have Medicare and ask them to verify coverage before your appointment. Provide your Medicare card number. The facility will check whether the test code and your diagnosis code are covered under Medicare rules for your area.

If the facility says the test may not be covered, ask your doctor to provide more detail about why the test is medically necessary. Sometimes a phone call from your doctor to the facility or to Medicare can clarify whether coverage applies. Do not assume you will owe the full cost — many tests that seem uncertain at first turn out to be covered once the medical reason is clearly documented.

Echocardiograms ordered in the emergency room or hospital

If you have an echocardiogram while you are admitted to the hospital or in the emergency room, the coverage and cost work differently. The hospital bills Medicare Part A (if you are admitted) or Part B (if you are in the ER and not admitted), and the cost is bundled into your hospital bill rather than billed separately.

If you are admitted to the hospital, you pay your Part A deductible and then coinsurance for each day you stay, not a separate charge for the echocardiogram. If you are in the ER and sent home without admission, the echocardiogram is covered under Part B, and you pay 20 percent coinsurance after your deductible, just as you would in an outpatient setting.

Ask the hospital billing department to explain your costs before you leave, or call them after you receive your bill. Hospital bills can be complex, and the billing staff can walk you through what Medicare paid and what you owe.

Portable and home echocardiograms

Some newer portable ultrasound devices can perform echocardiograms in a doctor's office or even at home. Medicare covers these if they are ordered for the same medical reasons as a standard echocardiogram — the setting does not change the coverage rules. Your doctor must still document the medical necessity, and the provider performing the test must be enrolled in Medicare.

Portable echocardiograms may be useful if you have mobility problems or live far from an imaging center. Ask your cardiologist whether this option is available and whether Medicare will cover it in your situation.

Frequently Asked Questions

Do I need a referral from my primary care doctor to get an echocardiogram covered by Medicare?

No, Medicare does not require a referral. Your primary care doctor, a cardiologist, or any other doctor can order an echocardiogram. What matters is that the doctor has a medical reason for ordering it and that reason is documented in your chart.

Will Medicare cover a follow-up echocardiogram if I had one last year?

Yes, if your doctor has a medical reason for a follow-up test. For example, if you had a heart attack last year and your doctor wants to check how your heart has healed, or if you have a valve problem that needs monitoring, a follow-up echocardiogram is covered. The timing and frequency depend on your condition and what your doctor recommends.

What happens if the imaging center says my echocardiogram is not covered?

Ask the facility to explain which part of the coverage rules your test does not meet. Then call your doctor's office and ask them to review the medical reason with the facility or with Medicare. Sometimes the issue is that the diagnosis code was not entered correctly, or the facility is unfamiliar with Medicare's rules for your specific situation. Your doctor can often resolve this with a phone call.

Can I get an echocardiogram at a private imaging center and have Medicare pay for it?

Yes, as long as the center is enrolled in Medicare and your doctor has ordered the test for a covered reason. The center's Medicare enrollment status is what matters, not whether it is part of a hospital system. When you call to schedule, ask the center to confirm they accept Medicare and that they will verify coverage before your appointment.

If I have a Medicare Advantage plan, does it cover echocardiograms the same way?

Medicare Advantage plans must cover everything Original Medicare covers, but they may have different costs — such as a copay instead of coinsurance — and they may have network requirements. Check your plan's coverage documents or call your plan to find out your specific costs and whether you need to use an in-network facility.