Medicare Coverage of Ultrasound
What It Is
Ultrasound diagnostic testing, also called sonography or ultrasonography
Medicare Part A or a Medicare Part C plan covers ultrasound diagnostic testing on a hospital or skilled-nursing-facility inpatient. Medicare Part B or a Medicare part C plan covers ultrasound diagnostic testing performed on an outpatient in any setting.
If you have a Medicare Part C Medicare Advantage plan: Deductibles and co-payments for Medicare Part C plans may be different than those for Medicare Part A or Medicare Part B. To find out whether your Medicare Part C plan charges different deductibles or co-payments for ultrasound diagnostic testing than Medicare Part A or Medicare Part B does, contact the plan directly.
What Medicare Pays
If a hospital or skilled-nursing-facility inpatient receives ultrasound diagnostic testing, the cost becomes part of the overall charges that Medicare Part A pays according to its schedule of inpatient coverage, which includes a deductible and co-payments for lengthy hospital stays. If ultrasound diagnostic testing is provided to an outpatient, the amount Medicare Part B pays depends on the setting in which the testing is provided. If the ultrasound testing is performed in a doctor's office, freestanding clinic, or independent testing facility, Medicare Part B pays 80 percent of the Medicare-approved amount. If the testing is conducted in a hospital outpatient department, Medicare Part B pays the full Medicare-approved amount, except for a set co-payment that the patient is responsible for.
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.
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