Does Medicare Cover a Calcium Score Test?

Usually not. If you're on Medicare and have no symptoms, a calcium score counts as a screening test, and Medicare doesn't pay for it, so most people cover the cost themselves. The same is true of a coronary CT angiogram (CCTA) done for screening. One bright spot: if you still have money in a health savings account, you can use it.

Why doesn't Medicare cover a calcium score?

Medicare is built to pay for tests that diagnose or treat a medical problem, plus a short list of named screenings. A calcium score isn't on that list, so when you don't have symptoms, Medicare treats it as screening it doesn't cover.

The detailed rules come from regional Medicare contractors, and one contractor's rules spell it out: no coverage for a screening scan in people without symptoms, whether for risk assessment or to measure coronary calcium. The US Preventive Services Task Force, whose grades shape which preventive tests get covered, has said the evidence is too limited to recommend for or against adding a calcium score to standard risk assessment.

Does Medicare Advantage cover a calcium score?

Sometimes. Medicare Advantage plans have to cover everything Original Medicare does, and some add extras on top. It varies plan by plan, so the quickest way to know is to call the number on your card before you book. Asking about billing code 75571 gets you a specific answer rather than a general one.

What if your doctor orders a calcium score?

A doctor's order doesn't turn a screening test into a covered one. If the imaging center expects Medicare to deny it, you may be asked to sign an Advance Beneficiary Notice, a form saying you'll pay if Medicare won't. It's worth asking for the self-pay price before you sign.

A CCTA is a different case when you have symptoms. Medicare covers it when your doctor orders one to look into chest pain or similar symptoms, and our guide to coronary CT angiogram cost explains what you'd owe under Part B.

If you're paying yourself, what are your options?

Paying out of pocket puts the choice in your hands, so it helps to know what each scan gets you. A calcium score has an estimated national average of $336, uses no contrast dye, and helps with a statin decision, though it only sees hardened plaque. A CCTA averages about $1,314 and uses contrast dye, and it also shows soft plaque, the newer kind that's often riskier.

A health savings account still helps here. Once you're enrolled in Medicare you can't put new money into an HSA, but you can spend what's already there on qualified medical expenses, a heart scan included.

The bottom line

For a screening heart scan on Medicare, expect to pay yourself unless your Medicare Advantage plan says otherwise. Veevo offers the CCTA and the calcium score as self-pay scans in California and New York, with the order handled for you; see current prices.