How Much Does a Stress Test Cost With Medicare?

A stress test is a diagnostic procedure that helps healthcare providers evaluate how well the heart functions under physical exertion or simulated stress. This test is often recommended to diagnose various heart conditions, such as coronary artery disease, or to assess the effectiveness of existing treatments. Understanding the potential costs associated with such procedures is important, particularly for those enrolled in Medicare.

Medicare Coverage for Stress Tests

Medicare covers stress tests when medically necessary. Most are covered under Medicare Part B, medical insurance for outpatient services, including diagnostic tests in a physician’s office or outpatient clinic. For coverage, qualified medical personnel must perform the test, and the provider must accept Medicare assignment.

If a stress test occurs during an inpatient hospital stay, Medicare Part A (Hospital Insurance) might cover facility costs. Routine stress tests are typically outpatient procedures under Part B. Medicare Advantage Plans (Part C) mirror Original Medicare (Parts A and B) coverage, though out-of-pocket costs and rules, like network requirements, can differ by plan.

Factors Affecting Your Stress Test Costs

Stress test costs, even with Medicare, vary based on several factors. The specific type of stress test is a primary factor. A basic exercise stress test, involving a treadmill and heart monitoring, is generally less expensive than more complex versions.

Pharmacological stress tests, for those unable to exercise, use medication to simulate exertion and cost more due to the drugs. Stress tests with advanced imaging, like echocardiograms or nuclear imaging, significantly increase expense. These require specialized equipment and radioactive tracers, adding to the cost.

The test setting also influences price. Hospital outpatient departments may cost more than independent clinics or physician’s offices, often due to facility fees. Beyond the test, costs include professional fees for the supervising physician and technical fees for equipment and personnel.

Understanding Your Out-of-Pocket Expenses

Even with Medicare coverage, beneficiaries are responsible for certain out-of-pocket expenses. For services covered under Medicare Part B, like stress tests, beneficiaries must first meet their annual deductible. For 2025, the Medicare Part B annual deductible is $257. This amount must be paid before Medicare begins to cover its share of approved services.

After the deductible is satisfied, Medicare typically pays 80% of the Medicare-approved amount for the stress test. The beneficiary is then responsible for the remaining 20% coinsurance. This 20% coinsurance may apply separately to both the facility fee and the physician’s professional fee, depending on how the services are billed. If a beneficiary is enrolled in a Medicare Advantage Plan, their out-of-pocket costs will likely involve a set copayment for diagnostic tests, which can vary significantly between plans.

To gain an accurate understanding of potential costs, beneficiaries should contact their healthcare provider and Medicare plan directly before the procedure. It is advisable to request the specific CPT (Current Procedural Terminology) codes for the stress test, such as 93015 for a basic exercise stress test or 78452 for a nuclear stress test, to obtain precise cost estimates. After the service, Medicare beneficiaries with Original Medicare will receive a Medicare Summary Notice (MSN), which details what was charged, what Medicare paid, and what the beneficiary owes. Those with a Medicare Advantage Plan will receive an Explanation of Benefits (EOB) from their private insurer, which serves a similar purpose by outlining the services received and the associated costs. Neither the MSN nor the EOB is a bill, but they are important documents for understanding financial responsibility.