Does Medicare Cover Electrocardiograms (EKG)?
Yes, Medicare covers electrocardiograms as long as they’re medically necessary. Your doctor needs to order the test as a way to diagnose specific symptoms you’re having, such as chest pain or shortness of breath. Medicare also covers EKGs if a doctor recommends one after your “Welcome to Medicare” preventive visit. This is a one-time, thorough examination of your overall health when you first get Medicare. After that, you pay 20% of the costs, and Medicare covers 80%.
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What Is an Electrocardiogram (EKG)?
An electrocardiogram (EKG or ECG) records the heart’s electrical activity over a specific period. It’s non-invasive, painless, and can help diagnose various heart conditions.
During an EKG, a medical provider places electrodes (small adhesive patches) on the chest, arms, and legs. These electrodes measure the heart’s electrical signals and send them to a machine that records them as waves. Your doctor can read these waves to see if you have an irregular heart rhythm, heart rate abnormalities, and other heart-related issues, like coronary artery disease. They may even be able to see if you’re having a heart attack.
An EKG is an important diagnostic tool when you’re having certain symptoms, such as:
- Rapid pulse
- Pain in the chest
- Dizziness or confusion
- Shortness of breath
- Weakness or fatigue
In the U.S., one person dies every 33 seconds from cardiovascular disease, and EKGs are essential for helping diagnose issues before they become deadly. Taking advantage of your Medicare benefits for EKGs could save your life.
Electrocardiogram vs. Echocardiogram
An electrocardiogram is different from an echocardiogram (echo). Instead of measuring electrical activity, an echo uses ultrasound to create images of the heart. Doctors use it to diagnose structural issues with the heart, like problems with the heart’s size, shape, muscle thickness, valve function, and blood flow patterns. Often, your doctor may order both an EKG and an echo to comprehensively assess your cardiac health.
Understanding How Medicare Covers the EKG
Medicare covers EKGs through your Part B coverage. Echocardiograms are also covered under Part B.
Part B covers both medically necessary and preventive healthcare services, including doctor’s visits and outpatient care. To use Part B coverage, you need to pay a $164.90 monthly premium. You must also pay a $226 deductible each year before Medicare pays any of your bills.
Once you’ve paid your deductible, Medicare pays 80% of the Medicare-approved amount for eligible EKGs and echos. You’re on the hook for the remaining 20%. Remember that if you go to a doctor who does not partner with Medicare, they may charge you more.
Medicare does not have a limit on how many EKGs or echos it covers. However, each test needs to be deemed medically necessary by your doctor. The one exception is your “Welcome to Medicare” preventive visit, where you may be eligible for a one-time EKG screening.
Medicare covers EKG testing when you have documented signs and symptoms of a heart condition. For example, your doctor might notice your heart’s rhythm is slowing down or speeding up without warning. You might also feel like your heart is skipping a beat. Other problematic symptoms include:
- Having chest pain
- Experiencing unexplained dizziness or lightheadedness
- Seeing a decreased performance during exercise
- Feeling short of breath
Finally, for your EKG test to be covered, it must also be reviewed and interpreted by your doctor.
How Medicare Advantage Covers the EKG and ECG
Medicare Advantage plans cover at least the same services as Original Medicare but are offered by private insurers. This could be good news if you need an EKG, as your Medicare Advantage plan might have more lax rules on what it covers. For example, your plan might allow you one free EKG screening a year instead of just one in your lifetime. Even if a doctor deems an EKG medically necessary, your coinsurance percentage might be less than with Original Medicare.
Each Medicare Advantage plan is different, so check with your provider to find out about specific EKG coverage.
How Much Do Electrocardiograms Cost With Medicare?
If the EKG is your first medical expense, you may have to pay the full $226 deductible, as the test usually costs more than this without Medicare’s coinsurance.
If you’ve already paid your deductible because of other medical expenses, then you pay 20% of the Medicare-approved amount. These amounts vary based on the specific procedure you’re having done and the billing code your doctor uses. As an example, using code 93224 (ECG monitoring and reporting after wearing sensors for 48 hours), you might pay up to $80.34.
If you have a Medicare Advantage plan, your copays and out-of-pocket maximums are likely unique, so check your plan’s literature to see what you might pay.
Putting It All Together
An electrocardiogram is crucial for diagnosing irregular heart rhythms and heart rate abnormalities. Luckily, Medicare offers coverage for this test if your doctor decides it’s medically necessary. You might also be able to get a one-time screening as part of your “Welcome to Medicare” preventive visit. After paying your deductible, you pay 20% of the bill. Having an EKG at the first sign of your symptoms can help you diagnose heart problems early to get the needed treatment.