Does Medicare Cover a Nuclear Stress Test?

If you’ve been experiencing chest pain or shortness of breath, your physician may suggest that you have a nuclear stress test. Health care providers commonly use nuclear stress tests to diagnose or rule out a heart condition. They are also used to develop a treatment plan and follow its progress for those who have coronary artery disease. 

Doctors perform nuclear stress tests by injecting small amounts of radioactive materials, called tracers, into their patients. Then they use an imaging machine like a PET, MPI, or SPECT scanner to get images of the blood flow through the heart. These tests measure the patient’s blood flow at rest and during activity and help doctors find areas in the heart that show damage or poor blood flow. 

If your physician wants to check the health of your heart by doing a nuclear stress test, you may need your Medicare benefits to help cover the expenses. Here’s a look at how your Medicare coverage can help you. 

Does Medicare insurance cover nuclear stress testing?

Medicare recipients who have their coverage through Original Medicare Parts A and B can get coverage for nuclear stress tests if they meet Medicare’s qualification requirements. Medicare Part B categorizes these Medicare benefits as diagnostic non-laboratory tests. 

When diagnostic non-laboratory tests are done on an outpatient basis, Medicare Part B (medical insurance) covers them. For nuclear imaging tests, coverage includes the imaging procedure as well as the radionuclides (tracers) that the physician uses during the procedure. Medicare Part B also covers PET scans and the necessary diagnostic imaging agents for these tests when the physician recommends these types of exams.

To be eligible for these Medicare benefits, your health care provider must order the tests as part of your treatment for a medical condition – either to diagnose or rule out a suspected condition or to review progress when a treatment plan has been put in place by the health care provider. 

Also, the physician who gives the order for the exam and the medical facility or hospital performing the exam must accept Medicare assignment. 

With coverage through Original Medicare Part B, Medicare pays 80 percent of the final, Medicare-approved amount for the nuclear stress test. You pay the remaining 20 percent as well as your Part B annual deductible. 

You can get extra help with your Part B coinsurance if you have a Medicare Supplement plan. Medicare Supplement (Medigap) plans A, B, C, D, F, G, M, and N cover 100 percent of your Medicare Part B coinsurance. Plan L pays 75 percent, and Plan K pays 50 percent of the coinsurance amount. 

Does Medicare Advantage cover nuclear stress tests?

If you have Medicare Advantage for your health care insurance, you are guaranteed the same benefits that are included in Original Medicare Parts A and B. So, if you qualify for a nuclear stress test, your plan must provide this benefit.

However, your plan may require that you have your testing done by health care providers and at medical facilities that are on the plan’s list of network providers. Also, if you need to visit a specialist, you may have to get a referral from your primary care provider first. You may not get your coverage if you go outside the plan’s network, so make sure you know which providers you can visit before making appointments. 

How much does a nuclear stress test cost without Medicare coverage?

Nuclear stress tests are quite common exams in the United States. In fact, more than 80 million people have one every year. There are several factors that determine the cost of a nuclear stress test, including location, who performs it, what medical facility you go to, the type of test you have, and others. But the national average cost for this type of medical procedure ranges between $3,800.00 and $4,115.00. 

If you aren’t sure whether you qualify for Medicare coverage for a nuclear stress test you should discuss it with your health care provider.

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