Does Medicare Cover Ultrasounds?
- Does Medicare cover ultrasounds? The answer is usually. Learn more about this non-invasive diagnostic procedure and its associated costs in this guide.
Ultrasounds are diagnostic tests that medical professionals use for a wide range of functions. They can help determine the composition of most bodily tissue, excluding bone and air-filled spaces.
Keep reading to find out if your Medicare plan covers the cost of ultrasound and discover if there are any exceptions or exclusions.
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Does Medicare Pay for Ultrasounds?
Medicare usually covers the cost of ultrasound services, provided the treatment has been recommended by a physician as medically necessary. This might be diagnosing a specific medical condition or screening the body to rule out an illness or condition.
The use of ultrasound technology is also covered by Medicare for the purpose of carrying out medical examinations and screenings.
If you've been recommended ultrasound treatment in an inpatient setting due to an incident or as part of a procedure, Medicare Part A usually covers the costs of your inpatient stay, such as the cost of your room. This includes skilled nursing facilities, hospitals and medical centers.
You can find a non-exhaustive list of the conditions Medicare covers ultrasound scans for on the Centers for Medicare & Medicaid Services website.
The majority of inpatient treatments are covered by Part A, but if you have a premium payment, you'll need to cover this yourself. You must also meet all out-of-pocket expenses until you hit your deductible before Medicare coverage kicks in.
Ultrasound in an Outpatient Setting
In many instances, Medicare Part B covers ultrasound testing in an outpatient setting. Preventative services such as examinations, lab tests and screening, supplies and other types of medically required outpatient care are included in Part B plans. While Part B is optional, your monthly premium may go up if you don't sign up for it.
When you use Part B, you're responsible for paying the remaining balance of your deductible and any premium payments. You also pay 20% of the Medicare-approved amount for doctors services, outpatient therapy and durable medical equipment.
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What Is an Ultrasound?
Ultrasound scans, also known as sonograms, use high-frequency sound waves to create anatomically correct images of the inside of the body. They're most frequently used to monitor unborn babies, guide surgeons during medical procedures and diagnose illnesses.
The technology works using a small device called an ultrasound probe, which gives off high-frequency sound waves. You can't hear them, but they bounce off the contours in the body and create echoes that the probe picks up and turns into a moving image. This picture is displayed on a monitor as the scan is being administered.
Most ultrasound scans usually last for 15 to 20 minutes and take place in a hospital or physician's practice. Sonographers, radiographers and other types of doctors might carry out ultrasound procedures. It's also possible for other medical professionals, such as midwives and physiotherapists, to perform ultrasound scans.
There are three types of ultrasound scans:
- External
- Internal
- Endoscopic
Below is a quick explanation of each to help you understand what to expect if you have an upcoming ultrasound appointment.
External Ultrasound
With this type of ultrasound, a doctor moves a handheld probe across the skin over the area that requires examination. They use a lubricating gel to help the probe move smoothly to ensure continuous contact and create an accurate image. Aside from the cold gel, you're unlikely to experience any pain.
Internal Ultrasound
For an internal ultrasound examination, practitioners insert a small probe no larger than a finger with a sterile cover internally. They're often used to examine internal organs such as the prostate, ovaries or uterus. They might cause discomfort but are rarely painful and don't take long.
Endoscopic Ultrasound
For an endoscopic ultrasound, a medical professional inserts an endoscope, usually through the mouth. Areas this type of scan is used for include the stomach and the esophagus.
The endoscope has an ultrasound probe and a light attached and performs the same function as any other ultrasound once inside the body. The procedure usually takes place under local anesthetic, with a sedative given to individuals who are nervous.
Side Effects
Unlike other diagnostic scans such as mammograms and CT scans, ultrasound doesn't expose you to radiation. There are no known risks associated with the high-frequency sound waves ultrasound uses, and they're usually painless and without side effects.
Does Medicare Cover Ultrasound If You Volunteered for the Procedure?
If you've volunteered yourself for an ultrasound scan or ultrasound therapy, there's a good chance Medicare won't cover it. Medicare Part A and Part B exist to cover the costs of medically necessary inpatient and outpatient treatments, as explicitly recommended by a medical professional.
Does Medicare Cover Ultrasounds in Inpatient and Outpatient Settings?
Medicare Part A covers ultrasound testing in inpatient settings, such as hospitals and medical centers and nursing care facilities. Medicare Part B covers ultrasound testing in outpatient settings such as doctor's offices, day surgeries, community health clinics and other specialized outpatient clinics.
