Does Medicare Cover an EKG?

An electrocardiogram (EKG) is a quick, painless medical test that records the heart’s electrical activity. Electrodes placed on your skin detect signals, which are translated into wavy lines. These recordings provide information about heart rhythm and rate, helping identify issues like irregular heartbeats or signs of heart damage. Medicare is a federal health insurance program primarily for individuals aged 65 or older, and some younger people with disabilities or specific health conditions, helping manage healthcare costs.

Medicare Part B Coverage for EKGs

Medicare Part B, which covers outpatient medical services, generally covers EKGs when medically necessary. Medical necessity means the service is reasonable and required to diagnose or treat an illness, injury, condition, or its symptoms, adhering to accepted medical standards. If a service does not meet these criteria, Medicare typically will not cover it.

Medicare Part B distinguishes between diagnostic and routine screening EKGs. Diagnostic EKGs are covered when ordered by a healthcare provider to investigate specific symptoms or diagnose a known condition. Routine screening EKGs, generally performed without specific symptoms, are typically not covered.

An exception for screening coverage is a one-time EKG during your “Welcome to Medicare” preventive visit. This visit must occur within the first 12 months of your Medicare Part B enrollment. The EKG serves as an educational and counseling service, if appropriate by your physician.

A standard resting EKG, which records heart activity while you are still, is covered for diagnostic purposes. Stress test EKGs, which evaluate heart function during physical activity, are also covered if medically necessary to diagnose heart conditions or assess heart function.

The Holter monitor is a portable device that records heart activity over an extended period, often 24 to 48 hours or up to 7 days. Medicare Part B covers Holter monitors when medically necessary, such as for individuals experiencing symptoms like arrhythmias, chest pain, or unexplained dizziness. This extended monitoring helps capture intermittent heart issues that a brief EKG might miss.

Understanding Your Costs

When Medicare Part B covers your EKG, you will have financial responsibilities. You must first meet your annual Part B deductible. For 2025, the Medicare Part B deductible is $257. This amount is paid once each calendar year for covered Part B services.

After your deductible is met, Medicare generally pays 80% of the Medicare-approved amount for the EKG service. You are responsible for the remaining 20% coinsurance. For instance, if the Medicare-approved amount for your EKG is $100 and you have met your deductible, Medicare would pay $80, and you would owe $20.

If you receive the EKG in a hospital outpatient department or a facility associated with a hospital, you might also be subject to a hospital copayment in addition to the 20% coinsurance. To manage your out-of-pocket costs, choose healthcare providers and facilities that accept Medicare assignment. Providers who accept assignment agree to accept the Medicare-approved amount as full payment, which helps limit your financial responsibility.

How Other Medicare Parts Apply

While Medicare Part B covers EKGs in most outpatient scenarios, other Medicare parts may apply depending on your care setting. If an EKG is performed while you are admitted as an inpatient to a hospital, its cost is typically covered under Medicare Part A, your hospital insurance. The EKG is considered part of the comprehensive inpatient services received during your hospital stay.

Medicare Part C, known as Medicare Advantage plans, offers an alternative to Original Medicare. These plans are provided by private insurance companies approved by Medicare. Medicare Advantage plans must cover at least the same benefits as Original Medicare (Parts A and B), including medically necessary EKGs. However, specific costs, such as deductibles, copayments, and coinsurance, and rules like network providers, may differ.

Medicare Part D, which provides coverage for prescription drugs, does not cover diagnostic tests like EKGs. Part D plans are specifically designed to help with the costs of medications you take at home.

Steps for Covered EKG Services

To help ensure Medicare covers your EKG service, a physician’s order is necessary. This order serves as documentation of medical necessity. This order confirms that the test is being performed for a valid diagnostic reason. Without a proper order, Medicare may not cover the service.

Confirm that your healthcare provider and the facility where you receive the EKG accept Medicare assignment. Providers who accept assignment agree to the Medicare-approved amount as full payment for services, which typically results in lower out-of-pocket costs. You can ask the provider’s office directly about their Medicare assignment status.

If a provider believes Medicare may not cover a service like an EKG, they should issue an Advance Beneficiary Notice of Noncoverage (ABN). An ABN is a written notice given to you before you receive services. It informs you that Medicare might not pay for the service and explains why. If you sign the ABN, you agree to be responsible for the cost if Medicare denies coverage.

After you receive services, review your Medicare Summary Notice (MSN). This document details the services you received, what Medicare paid, and the amount you may owe. Reviewing your MSN allows you to verify billed services match those received and helps you understand your financial obligations.