A heart scan is a non-invasive diagnostic procedure that uses specialized imaging technology to create detailed pictures of the heart and blood vessels. These images allow physicians to assess the heart’s structure, function, and blood flow, helping to identify potential cardiovascular issues. The purpose of seeking a heart scan is often to gain a clearer understanding of heart health or to investigate symptoms. Navigating where to get this testing and understanding the potential financial impact is a necessary first step in accessing this care.
Understanding the Different Types of Heart Scans
The term “heart scan” covers several different imaging technologies, each designed to view a specific aspect of heart health. A common procedure is the Coronary Artery Calcium Scoring (CACS), which uses a Computed Tomography (CT) scan without contrast material to measure calcified plaque in the heart’s arteries. The resulting Agatston score helps predict the risk of future heart events by quantifying the amount of atherosclerosis present.
Another frequently used test is the Echocardiogram, often referred to as an “Echo,” which employs high-frequency sound waves to create moving images of the heart as it beats. An Echo is valuable for evaluating the heart’s pumping function, valve operation, and overall structure, and it does not use radiation.
Lastly, a Cardiac Magnetic Resonance Imaging (MRI) scan uses a powerful magnetic field and radio waves to produce detailed images of the heart chambers, muscles, and surrounding vessels. Cardiac MRI is used for assessing heart size and function, and for characterizing tissue, such as identifying scar tissue or inflammation.
Facilities That Offer Cardiac Imaging
Heart scans are administered in several distinct clinical settings, and the choice of location can influence accessibility and cost. Large Hospital Cardiology Departments are comprehensive centers that typically offer the full spectrum of cardiac imaging services, including advanced tests like Cardiac MRI and specialized stress echoes. These settings provide the convenience of having all services under one roof, often with immediate access to specialists.
Independent Outpatient Diagnostic Centers and Imaging Clinics are facilities dedicated solely to performing imaging procedures, including CT and MRI scans. These centers often have a focused expertise in image acquisition and interpretation, and they may offer more flexible scheduling than a busy hospital setting. The same heart test may be significantly more expensive at a hospital outpatient department compared to an independent practice, due in part to hospital facility fees.
Specialized Cardiology Private Practices may also house their own imaging equipment, most commonly for echocardiograms and sometimes for nuclear stress testing. Using a private practice for imaging can offer a more personalized experience and may provide cost savings compared to the higher rates charged by hospital systems. Patients seeking a heart scan should inquire about the exact location where the procedure will be performed, as some physician practices partner with an adjacent or nearby hospital.
Navigating Referrals and Appointments
The process of securing a heart scan generally begins with a physician referral, which is a required step for most diagnostic imaging procedures. A primary care physician (PCP) or a cardiologist will determine the medical necessity of the scan based on symptoms, risk factors, and existing medical history. This initial clinical assessment is documented and included with the referral request sent to the imaging facility.
Once the referral is generated, the imaging facility or hospital will initiate a process called pre-authorization with the patient’s insurance company. This step confirms that the specific scan being ordered is covered under the patient’s plan and meets the insurer’s criteria for medical necessity. Waiting for pre-authorization can sometimes be the longest phase of the scheduling process.
When the appointment is confirmed, patients should ensure they bring any relevant medical records, a list of current medications, and their insurance information. For certain scans, like a Coronary Artery Calcium Score, no special preparation is typically needed. For others, such as a Cardiac MRI, specific instructions regarding fasting or medication may be provided. Adhering to the facility’s instructions is important for ensuring the accuracy of the test and preventing delays on the day of the procedure.
Financial Considerations
The cost of a heart scan can vary substantially, sometimes exhibiting a tenfold difference in the median price of a procedure like an echocardiogram across different top-ranked hospitals. This variation is influenced by the type of facility, the specific procedure, and the negotiated rates between the provider and the patient’s insurance plan. Studies have shown that for an echocardiogram, the median negotiated price can range widely, highlighting the importance of price transparency.
Patients with insurance will face costs determined by their plan’s structure, including deductibles, co-pays, and co-insurance. A key distinction in coverage is whether the scan is considered diagnostic (to investigate symptoms) or purely preventative screening. For example, Coronary Artery Calcium Scoring (CPT code 75571) is a common preventative test, and many insurers and Medicare classify it as a screening service, which means it is often not covered.
For procedures not covered by insurance, or for patients with high deductibles, self-pay options are often available, and patients should confirm the CPT code with the provider to check coverage with their insurer beforehand. The self-pay price for a CACS is often significantly lower than the list price billed to insurance, sometimes ranging from $100 to $400, depending on the market and facility. Patients should proactively contact the facility’s billing department to inquire about the self-pay rate and avoid unexpected charges.