Does Medicare Cover a Nuclear Stress Test? 

When someone first hears about taking a nuclear stress test, this news by itself can cause stress. Nuclear tests on the human body? The truth, however, is that nuclear stress tests are safe ways to check cardiovascular health. These tests rely on a small amount of radioactive material called a radiotracer that gets mixed with saline which is then introduced to your blood via intravenous injection.

Once the radiotracer is circulating, you may be asked to perform a series of simple exercises. After your heart reaches the optimal level of activity, a special machine called a positron emission technology (PET) scanner can see the blood as it flows through your body. This machine also images the heart and nearby systems to check their functionality. The harmless radiotracer is eventually passed through the digestive system and excreted through urination and bowel movements.

Why is a nuclear stress test performed?

Most doctors prescribe a nuclear stress test if heart problems are suspected. If you have experienced high levels of cholesterol, a nuclear stress test can measure blood flow through your coronary arteries to see if blockages exist.

These tests may also be necessary if you have undergone or are currently undergoing treatment for a heart issue. Following heart surgery or after some time on a new heart medication, your doctor will need to follow up with you to see if the treatment has been successful and if any adjustments need to be made.

Does Medicare cover a nuclear stress test?

Heart disease is a serious matter, and in most cases, addressing these issues is a matter of medical necessity. While it’s never good to have a heart condition, it is good to know that Medicare insurance generally covers nuclear stress tests when they are a medical necessity. Much like anything to do with Original Medicare benefits, your nuclear stress test will need to be ordered by a Medicare-participating physician  and performed in a facility that accepts Medicare in order to qualify for coverage.

Outpatient benefits through Medicare Part B tend to make up the bulk of coverage for nuclear stress tests. This is because these types of tests are generally administered in an outpatient setting, and Medicare coverage through Part B is designed to cover outpatient procedures, lab tests, doctor visits, surgery and durable medical equipment.

Inpatient Medicare coverage for nuclear stress tests

Inpatient treatment is covered by Medicare benefits under Part A. This portion of Original Medicare supplies benefits for treatment and services provided while formally admitted to a Medicare-participating hospital or skilled nursing facility.

In general, Medicare recipients can take advantage of up to 60 days at 100% coverage for inpatient services each year. If further inpatient treatment is needed, an additional 30 days can be used at a discounted rate, and further days can be covered if Medicare recipients use lifetime reserve days.

Medicare Part D coverage for heart health

If a nuclear stress test finds that you are experiencing cardiovascular problems, Original Medicare benefits can often be used to treat cardiovascular healthcare concerns. As mentioned above, Medicare Parts A and B supply inpatient and outpatient care, respectively, but Medicare Part D can also assist heart patients with coverage for prescription medications.

Different Part D plans have different limitations and benefits when it comes to certain prescription drugs, so it’s always a good idea to work with your doctor, cardiologist, testing lab or any other medical professionals involved in your care to ensure that you are able to get the right medications to treat your condition. If a specific drug is required to treat your condition and your plan does not provide Medicare coverage for it, your doctor may be able to work with you to file an exception waiver. 

Medicare Advantage benefits for a nuclear stress test

Medicare Advantage plans are required to include the same benefits as Original Medicare Part A and Part B, but most plans include additional coverage. Additional benefits may include vision and dental care, hearing aids and exams, fitness memberships, prescription drugs, and more. 

If you have questions about your specific benefits and costs, contact your plan directly.