Medicare Coverage of Electrocardiograms (EKGs)
This article was updated on: 09/12/2018
According to the Centers for Disease Control and Prevention, or CDC, Americans suffer from coronary artery disease more than any other kind of heart disease. Tragically, the first time that many people realize they have this disease is after they suffer from a heart attack. However, people can work with their doctors to proactively detect and treat heart problems before they become life-threatening emergencies.
People who might be at a greater risk for heart disease include older adults and those with a family history of similar problems. Certain risks factors, such as family history and age, may be out of your control. However, lifestyle changes, medications, and, in some cases, surgery can help control and prevent serious complications.
Since the risk for coronary artery disease and other issues increases with age, a diagnostic test like an electrocardiogram (EKG) can be life-saving. Read on to learn more about Medicare coverage for EKGs.
How an EKG helps doctors detect heart disease
To diagnose coronary artery disease in patients, doctors might order an electrocardiogram, which is a type of heart scan that is usually referred to as an EKG. This type of heart scan records the heart’s electrical activity and can help doctors detect past heart attacks, heart attacks in progress, and potential problems that might lead to serious medical problems in the future. In addition to coronary artery disease, other medical problems that a heart scan might uncover include congenital defects, inflammation, and arrhythmia (a heartbeat that is too slow, too rapid, or irregular).
Medicare coverage for electrocardiograms
Beneficiaries with Medicare Part B may be covered for electrocardiograms in certain circumstances:
- A doctor or other health-care provider might refer you for a one-time EKG screening after your “Welcome to Medicare” exam.
- A medical practitioner might refer you for a heart scan at another time as a medically necessary diagnostic test.
With Original Medicare, Part B provides Medicare coverage for electrocardiograms at 80%, and you’re responsible for paying 20% of the Medicare-approved amount for the test, after reaching the Part B deductible. If the EKG gets done inside of a hospital or facility that is associated with a hospital, you might also need to pay a copayment to the hospital.
Of course, your costs may be different if you’re enrolled in a Medicare Supplement or Medicare Advantage plan that may pay some or all of your heart scan copayment and deductible. Medicare Advantage plans are an alternative way to receive your Medicare Part A and Part B coverage, and these plans may have lower costs than Original Medicare. Medicare Supplement plans work alongside your Original Medicare coverage and may help pay for certain out-of-pocket costs.
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Centers for Disease Control, “Coronary Artery Disease (CAD),” last updated August 10, 2015.
National Institutes of Health, “What Does an Electrocardiogram Show?” last updated October 1, 2010.
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