How much does medicare pay for echocardiogram

An echocardiogram is an ultrasound of your heart that provides information on how it's structured and functions, and it can detect irregularities or problems.

A similar test, called an electrocardiogram (EKG), measures the electrical activity of your heart to make sure it's working correctly. These tests are often performed if there is an issue with your heart rhythm.

Both heart tests would be covered by Medicare as part of your one-time "Welcome to Medicare" visit, or as a diagnostic test if you're having pain, irregular rhythms, or other problems related to your heart. If you get a referral from your doctor for this screening and it's considered medically necessary, it will be covered under Part B.

Echos and EKGs are common, and your doctor may recommend you get one to ensure everything is functioning as it should. Read on to learn about Medicare coverage for these tests, when you would need one, how to prepare, and what to expect.

What part of Medicare applies to EKGs?

Medicare Part B (medical insurance) covers many doctors' services, outpatient hospital care, durable medical equipment (DME) and supplies, and preventive services and screenings you may need.

These services are covered when they're considered "medically necessary," which means they are needed to diagnose or treat a condition, or as preventive services, which help detect illness and conditions early.

An EKG or echocardiogram heart test would fall into the "medically necessary services" category because they would be used to help diagnose a medical condition related to your heart, and allow your doctor to create a treatment plan to fix the problem or help prevent it from getting worse.

Note: If you get an EKG or echo while you're an inpatient in a hospital or skilled nursing facility, the test will be covered by Medicare Part A (hospital insurance).

What does an echocardiogram reveal?

Both an echocardiogram and EKG function as diagnostic tests to help your doctor understand how your heart is functioning and figure out if or where there are any problems. While sometimes the terms are used interchangeably, they are different tests.

• Electrocardiogram (ECG or EKG): This test is done to help detect a heart problem, as well as monitor your overall heart health. An EKG may be used to reveal an abnormal heart rhythm, blocked or narrowed arteries in your heart, whether you've had a previous heart attack, or how well treatments (such as a pacemaker) are working.
  • It can also show an irregular heart rate, if you have an inadequate blood and oxygen supply to your heart, or if you have structural abnormalities.
• Echocardiogram: An echo uses sound waves to produce images of you heart that show your doctor how your heart beats and pumps blood. It may reveal problems with the valves or chambers of your heart or if heart problems are the causes of other symptoms, like chest pain or shortness of breath.
  • It can also show if you have an abnormal pumping strength, damage to your heart muscle, or other heart defects.

Both procedures are non-invasive, which means the tools used don't break the skin or physically enter your body. Instead, standard tests require placement of a patch-like device called an electrode onto your chest, which records sound waves or electrical signals in your heart.

When would your doctor order an electrocardiogram?

Whether your doctor orders an echo or EKG depends on your symptoms.

You may need an EKG if you're experiencing:

• Chest pain
• Dizziness or lightheadedness
• Confusion
• Heart palpitations
• Rapid pulse
• Shortness of breath
• Weakness, fatigue, or decline in ability to exercise

You may need an echocardiogram if you have:

• Shortness of breath
• Chest discomfort
• Swelling in the legs

An echo could also be scheduled if something abnormal is detected in an exam, like a heart murmur.

How to prepare for an electrocardiogram

Fortunately, neither an EKG nor a standard echo require much preparation. You can eat, drink, and take medications as you normally would. However, be sure to tell you doctor which medications or supplements you take because that could affect the results of your test.

There are different types of echocardiograms other than the standard transthoracic test. If you are having one of those performed, you may need to limit food or liquid intake for a few hours beforehand. Be sure to ask your doctor if there is anything you should or shouldn't do prior to your test.

What to expect when you get an EKG

Regardless of which test you get, it can help put your mind at ease to know what to expect before, during, and after.

EKG

Before your EKG, you may be asked to change into a hospital gown. The technician may shave any hair you have on the parts of your body where electrodes will be placed to ensure the patches stick to your skin, including your chest and arms.

Once ready, you'll lie on an exam table or bed and up to 12 electrodes will be attached to your chest and limbs. These electrodes are sticky patches with wires that connect to the heart monitor. Through these electrodes, your heart's signals will be recorded and a computer will display the beat as waves.

The test only takes a few minutes, but you'll need to be very still, so make sure you're comfortable. After the test ends, you can resume daily activities as you normally would.

Echocardiogram

During a standard transthoracic echo, you'll undress and lie on an exam table. The technician will attach electrodes to your body that will help detect and conduct your heart's electrical currents. They will also apply a gel to the transducer, which is like an ultrasound wand, and helps to improve the conduction of sound waves.

Once you're ready, the technician will move the transducer back and forth across your chest to record images of your heart. Be prepared to be asked to breathe a certain way or readjust your body to get different readings.

Echos take less than an hour, and once you're finished, you can resume your normal day.

Other medically necessary heart tests covered by Medicare

Other than an EKG and an echo, Medicare covers other medically necessary heart tests if ordered by your doctor. These can include:

• A cardiac CT scan, which shows details of your heart and blood vessels. This imaging scan can help detect certain heart conditions, such as coronary artery disease.
• Cardiac catheterization can help diagnose or treat certain heart conditions. During this procedure, a small tube is threaded from another part of the body to your heart.
• Stress tests show how your heart works during physical activity and can be used to diagnose heart conditions such as coronary artery disease, heart failure, and heart valve disease.
• A chest X-ray can be used to diagnose heart failure or lung disorders. This imaging can take pictures of your heart, lungs, and blood vessels inside your chest.
• A cardiac MRI is another imaging test that creates pictures of your heart and can help diagnose and show heart disease and other conditions. Using the results, your doctor can develop a treatment plan.
• A coronary angiography shows the buildup of plaque inside your arteries.

While these tests are covered, the Part B deductible may apply. You may also have 20% co-insurance.

If you receive one of these tests while an inpatient in a hospital, the Part A deductible and co-insurance would apply.

Need help understanding your Medicare plan options?

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