Medicare Coverage of an EKG (Electrocardiogram)


What It Is

EKG (electrocardiogram) diagnostic test

What's Covered

Medicare Part B covers an electrocardiogram if the test is prescribed to diagnose a condition, not merely for general cardiac screening.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for an EKG, contact the plan directly.

What Medicare Pays

For an EKG performed in a hospital outpatient department, Medicare Part B pays the full Medicare-approved amount, except for a patient co-payment. For an EKG in any other setting, Medicare Part B pays 80 percent of the Medicare-approved amount.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

Was this medicareinformation helpful?

3 Comments So Far. Add Your Wisdom.

Anonymous said over 1 year ago

Thank you so much for this information! I have been trying to find a <a href="http://www.atriohp.com/Who-We-Are.aspx">medicare advantage plan in Salem Oregon</a>, and this has been so helpful, thank you!


Anonymous said over 2 years ago

I KNOW ITS VERY BAD, I DO MEDICAL BILLING AND WE SOMETIMES CANT BILL THE EKG BECAUSE WE DID IT AS A SCEENING. THE DOCTORS FEEL ONCE A YEAR ANYONE OVER 50 NEEDS AN EKG JUST TO SCREEN. AND MEDICARE ONLY PAYS LIKE $23.00 FOR IT WHEN THEY DO PAY SO ITS NOT LIKE IT COSTING THEM $$$$$ AND THE FACT THAT MEDICARE PAYS SO LITTLE THE PLACE THAT CHARGED YOU 320 IS UPSETTING IF YOU WOULD HAVE HAD CHEST PAIN MEDICARE WOULD HAVE COVERED IT AND THAT OFFICE WOULD HAVE ONLY MADE $23.00 THE DOCTORS OFFICE SHOULD TRY TO HELP YOU AND AT LEAST CHARGE YOU WHAT MEDICARE WOULD HAVE PAID THEY TOOK ADVANTAGE OF YOU


about 4 years ago

I went to the out-pt. dept of Lewis -Gale Hospital in Salem, Va. where I will be having out-pt. surgery tomorrow morning. The doctor ordered an EKG as part of my pre-op work-up wince I am 70 years old. I was told by the receptionist that Medicare no longer pays for EKGs unless they are "diagnostic". Imagine my shock at learning that the cost was $320 !!! I did get a discount for paying the fee yesterday. Needless to say, I was very upset !! What are senior citizens on fixed incomes supposed to do ?? Also, Medicare will no longer cover prescriptions for "Symptoms", which included cough syrups and decongestants. I am a retired RN and am very worried about the state of our Medicare system.


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