Medicare can cover a medically appropriate diagnostic ultrasound ordered to investigate or manage a health problem. Coverage is not a benefit for every ultrasound sold by a clinic. The reason for the test and the exact service matter.
Identify which ultrasound is ordered
CMS national policy 220.5 lists covered diagnostic uses, a noncovered category and other uses left to local contractor review. Examples in the policy include certain abdominal, cardiac and vascular examinations. A listed technique still needs to be appropriate for the patient's medical situation.
| Situation | Coverage question |
|---|---|
| Diagnostic examination | Does the order document the medical reason? |
| Preventive screening | Does a specific screening benefit and its eligibility apply? |
| Ultrasound-guided procedure | Are the procedure and guidance services covered? |
| Therapeutic ultrasound | Which separate treatment policy applies? |
Understand the likely bill
For covered non-laboratory diagnostic tests in a doctor's office or independent testing facility under Original Medicare, the usual share is 20% of the approved amount after the Part B deductible. Hospital outpatient services may have a separate hospital copayment. Supplemental coverage can affect what you ultimately owe.
Ask whether the estimate includes both the scan and its interpretation. A no-cost preventive benefit for another test does not make every follow-up ultrasound free.
Before the appointment
- Confirm the order reached the testing center.
- Check the exact location and accepting provider.
- With Medicare Advantage, verify network and authorization rules.
- Ask about any anticipated noncoverage and required notice.
Keep the order and coverage response. If a claim is denied, compare the billed service and documented reason with the official notice. Discuss clinical necessity with your treating provider; this page does not recommend screening or select an imaging test.
Related coverage questions
- Original Medicare: What Parts A and B Cover and How You Pay
- A Medicare Medical Claim Was Denied: What to Do Next
- How to Compare Medicare Advantage Plans: A Practical Worksheet