An electrocardiogram, commonly known as an EKG or ECG, is a quick, non-invasive test that records the electrical activity of the heart. This diagnostic tool helps physicians detect a wide range of heart problems, including arrhythmias, heart attacks, and coronary artery disease. Understanding the cost of this procedure under Medicare can be complex, as the amount you pay depends on several factors. An EKG is a covered medical service, but calculating your specific financial responsibility requires looking closely at how Medicare processes the claim.
Standard Coverage Under Medicare Part B
The primary source of coverage for an EKG is Medicare Part B, which handles outpatient medical services and diagnostic tests. Medicare covers the EKG procedure when it is considered medically necessary to diagnose or treat a health condition. Part B also covers a one-time routine EKG screening if referred by a doctor during the “Welcome to Medicare” preventive visit, which must occur within the first 12 months of enrolling in Part B.
The standard cost-sharing structure under Original Medicare means Medicare pays a set percentage of the service’s approved amount. Once you have met the annual Part B deductible, Medicare covers 80% of the Medicare-approved amount for the EKG. The beneficiary is responsible for the remaining 20% coinsurance.
The Medicare-approved amount is the fee schedule that Medicare sets for a service, not the amount the provider initially bills. For a routine, 12-lead EKG, the approved amount is generally modest, meaning the 20% coinsurance is often a relatively small dollar amount.
Factors Influencing Your Out-of-Pocket Cost
Your final out-of-pocket cost for an EKG is not a fixed price and is heavily influenced by whether you have satisfied the annual Part B deductible for the current calendar year. For 2025, this deductible is $257, and until you meet this amount, you are typically responsible for 100% of the Medicare-approved amount for covered Part B services.
The setting of care also significantly impacts the total bill, even for the same EKG procedure. Getting the test done in a physician’s office or an independent clinic generally results in a lower overall cost. If the EKG is performed in a hospital outpatient department, the total bill is often higher because the hospital charges an additional facility fee.
In a hospital outpatient setting, you must pay the standard 20% Part B coinsurance, and you may also be required to pay a separate hospital copayment. This additional copayment is not required in a physician’s office. Selecting a testing location that is not affiliated with a hospital can help lower your overall financial burden.
The type of EKG test ordered further affects the total cost due to varying Medicare-approved amounts. A simple, resting 12-lead EKG (CPT 93000) will have a much lower approved amount than more complex diagnostic procedures. Continuous cardiac monitoring, such as a Holter monitor worn for several days, or a cardiac stress test, involves significantly higher technical and professional costs.
Since Medicare covers these more involved tests under Part B, the 20% coinsurance requirement still applies after the deductible is met. Because the total Medicare-approved amount for a Holter monitor or stress test is substantially higher, your resulting 20% coinsurance payment will also be much larger.
How Medicare Advantage and Medigap Affect EKG Costs
Beneficiaries who choose a Medicare Advantage plan (Part C) receive their Part A and Part B benefits through a private insurance company. These plans are required to cover all the same medically necessary services as Original Medicare, including EKGs. However, Medicare Advantage plans set their own cost-sharing rules, meaning out-of-pocket expenses for an EKG may be structured as a fixed copayment or a different coinsurance percentage.
The specific copayment or coinsurance amount for diagnostic services varies widely from plan to plan. You must use in-network providers to get the lowest cost. It is necessary to consult the plan’s Evidence of Coverage document to understand the exact payment structure for diagnostic tests. These plans also have annual out-of-pocket maximums.
Conversely, Medigap policies, or Medicare Supplement Insurance, work alongside Original Medicare to fill in the cost-sharing gaps. These policies do not replace Original Medicare but cover the portion that Original Medicare does not pay. Depending on the specific Medigap plan selected, it may cover the 20% Part B coinsurance for the EKG entirely.
Certain Medigap plans may also cover the annual Part B deductible, effectively reducing your cost for the EKG to zero once the claim is processed. Medigap provides predictable cost-sharing for beneficiaries who want to minimize their out-of-pocket expenses for services like EKGs and other diagnostic procedures.