An echocardiogram is a non-invasive diagnostic test that uses high-frequency sound waves to create moving images of the heart. Often called a cardiac ultrasound, this technology allows physicians to visualize the heart’s structure and function in real-time. The test evaluates the heart’s size and shape, assesses valve function, and measures blood flow through the chambers. Medicare generally covers this procedure when a healthcare provider determines it is necessary for a patient’s care.
Part B Requirements and Medical Necessity
Coverage for an echocardiogram performed in an outpatient setting, such as a doctor’s office or clinic, is provided through Medicare Part B. For the test to be covered, it must be considered “medically necessary,” meaning the procedure is required to diagnose, monitor, or treat a specific medical condition.
A physician orders an echocardiogram if a patient exhibits symptoms like unexplained shortness of breath, chest pain, or an irregular heartbeat. The resulting images help the doctor check for issues such as weak heart muscle, valve disease, or blood clots. To ensure coverage under Part B, the test must be ordered by a qualified healthcare professional, and the facility performing the service must accept Medicare assignment.
Coverage in Inpatient and Advantage Plan Settings
When an echocardiogram is performed while a beneficiary is formally admitted to a hospital, coverage falls under Medicare Part A. This occurs when the test is part of the overall diagnostic workup or treatment plan during a medically required inpatient stay. The cost of the echocardiogram is bundled into the hospital stay and is subject to the Part A deductible structure.
If a beneficiary is enrolled in a Medicare Advantage Plan (Part C), the plan must cover the same medically necessary services as Original Medicare (Parts A and B). Patients with a Part C plan may be required to use providers within the plan’s network to receive full coverage. Many Medicare Advantage plans also require prior authorization before the test can be received.
Understanding Deductibles and Coinsurance
For an echocardiogram covered under Part B, the beneficiary must first satisfy the annual Part B deductible (e.g., $257 in 2025). Once the deductible is met, Medicare covers 80% of the Medicare-approved amount for the procedure.
The patient is responsible for the remaining 20% coinsurance of the approved cost. This 20% can represent a significant out-of-pocket expense, as the total cost varies widely depending on the facility. Many beneficiaries purchase a Medigap policy, which is supplemental insurance designed to help cover this 20% coinsurance and the Part B deductible.
Part A costs follow a different financial structure based on benefit periods. The Part A deductible (e.g., $1,676 per benefit period in 2025) applies to the entire hospital stay, including the echocardiogram. After this deductible is met, the patient owes $0 coinsurance for the first 60 days of the inpatient stay.
Frequency Limitations and Exclusions
The “medical necessity” rule also dictates how often the test can be repeated, limiting its frequency. A repeat echocardiogram is only covered if there is a new or changed medical indication that warrants a follow-up test. Routine check-ups without new symptoms or a change in a diagnosed condition are not sufficient for coverage.
Coverage is excluded for uses defined as purely screening measures, such as ordering the test without symptoms or a known heart condition. If the test is ordered for experimental purposes or for conditions not recognized by Medicare’s coverage rules, it will likely be denied. If a physician orders a repeat test, they must provide clinical documentation justifying a significant change in the patient’s status or a new medical concern.