Does Medicare Cover Carotid Artery Screenings?

Does Medicare Cover Carotid Artery Screenings

Carotid artery screenings can help detect cardiovascular disease and reduce your risk of stroke, heart attack, and death.

In the U.S., someone has a heart attack every 40 seconds. That's about 805,000 people each year. Heart disease is also the leading cause of death for men, women, and people of most racial and ethnic groups in the U.S.

Between 2015 and 2018, 126.9 million American adults had some form of cardiovascular disease, causing both heart attacks and strokes, and costing more than $219 billion in direct and indirect health care costs.

While these statistics may seem scary, the good news is there are things you can do to and steps you can take to lower your risk of heart disease, heart attack, and stroke. Examples include eating a healthier diet, exercising more, and quitting smoking if you currently smoke. Another way to lower your risk is talking to your doctor about cardiovascular screenings or services you may be eligible or due for.

Medicare covers several cardiovascular disease screenings and services, both as preventive care and as diagnostic or treatment. Knowing what services are covered and when is an important part of maintaining your heart health. Read on to learn about carotid artery screening and other cardiovascular disease screening coverage, as well as the importance of these screenings.

Carotid artery screening Medicare coverage

Carotid arteries are the two main arteries that carry oxygen-rich blood from your heart to your brain, expending through each side of the neck. Carotid artery screenings can help to find carotid artery disease, which occurs when plaque (a build-up of fat, cholesterol, and other substances) collects along the walls of the arteries.

Over time, these arteries thicken and become stiff, and the blood vessel may even become narrow, which limits blood flow. This could lead to a stroke.

Carotid artery screenings include lab tests that check for blood flow, genetic tests, and imaging exams such as a carotid duplex ultrasound or carotid intima media thickness (IMT) ultrasound. This safe and painless test helps produce pictures inside the body using sound waves to:

  • Assess blood flow
  • Measure the speed of blood flow
  • Estimate the diameter of a vessel and degree of obstruction
  • Measure the thickness of the carotid artery walls

Some examples of these noninvasive tests of carotid function include carotid phonoangiography, direct bruit analysis, spectral bruit analysis, doppler flow velocity, ultrasound imaging, periorbital directional doppler ultrasonography, and others. While this list isn't exclusive, and names of these tests are not technically standardized, they are covered by Medicare. Check with Medicare or your doctor to ensure coverage prior to completing your test.

Cardiovascular disease screenings covered by Medicare

Medicare Part B covers cardiovascular screening blood tests once every five years. These screenings are blood tests to help detect conditions that may lead to a heart attack or stroke, including:

  • Cholesterol
  • Lipid
  • Triglyceride levels

As long as your doctor or provider accepts Medicare assignment, you pay $0 for these tests. However, during the screening, your doctor may discover and need to investigate or treat a new or existing problem. This care is considered "diagnostic," which means you may be billed for that care.

Because these screenings are part of the preventive screenings and services Medicare covers to keep you healthy, you don't need to show signs of heart disease or have any specific risk factors to be eligible.

Other heart-related screenings Medicare covers include:

  • Abdominal aortic aneurysm screening: This screening is covered by Part B once in a lifetime if you're at risk. You're considered at risk if you have a family history of abdominal aortic aneurysms, or you're a man ages 65-75 and have smoked at least 100 cigarettes in your lifetime. You must get a referral from your provider for this test to be covered.
  • Cardiovascular behavioral therapy: One visit per year with your primary care provider (PCP) is covered by Part B. This visit, where you'll talk to your PCP about aspirin use, your blood pressure, and eating well, helps lower your risk for cardiovascular disease.

Additionally, you can talk to your doctor about your risk factors and any screenings or services you may need during your yearly "wellness" visit, which you can get once every 12 months. This visit isn't an exam, but your doctor should take your height, weight, blood pressure, and other routine measurements, and talk to you about your risk factors, treatment options, and screening schedule.

Other cardiovascular disease coverage by Medicare

In addition to screenings, Medicare covers other cardiovascular disease-related needs.

  • Medicare Part A will cover hospitalization for a heart condition, such as heart surgery and stroke. Coverage also includes medications, equipment, tests, therapies, and other services you may need while an in-patient.
  • In addition to preventive screenings, Medicare Part B would also cover outpatient treatments you may need. Some heart procedures, like angioplasties and stents, are outpatient procedures and would be covered. Echocardiograms, cardiac catheterizations, and other scans may be covered as well.
  • Cardiac rehabilitation programs are covered if you've had a heart attack in the last 12 months, coronary artery bypass surgery, current stable angina, a heart valve repair or replacement, a coronary angioplasty, a heart or heart-lung transplant, or stable chronic heart failure. The programs include exercise, education, and counseling, and you pay 20% of the Medicare-approved amount as well as a co-pay if received in a hospital outpatient setting. The Part B deductible applies.
  • Cardiac stress tests, performed to evaluate a patient for the presence or severity of coronary artery disease, exercise-induced arrhythmias or hemodynamic changes, and/or cardiac functional capacity, are covered for those who meet certain criteria or are considered high-risk, and it must be considered medical necessary.
  • Cardiac catheterization, which is when a catheter is positioned into the heart to assess cardiac function and structure, must be medically reasonable and necessary for any coverage.

If you aren't sure if your test, item, or service is covered, you can use Medicare's Coverage Search Tool to learn more. Or, talk to your provider or health care team.

Importance of cardiovascular screenings

Cardiovascular screenings help prevent and treat heart disease before you have a heart attack or stroke.

For example:

  • High blood pressure increases your risk of heart disease and stroke. Having your blood pressure checked regularly and aiming to keep it around 120/80 helps lower your risk.
  • Cholesterol blood test measures your total cholesterol, LDL (bad) cholesterol, and HDL (good) cholesterol. Having too much "bad" cholesterol and/or too little "good" cholesterol can increase your risk for heart disease and stroke.
  • Having high blood glucose, or blood sugar levels, can put you at risk of developing insulin resistance or type 2 diabetes, which can lead to heart disease and stroke if untreated.
  • High levels of triglycerides in your blood can increase your risk of heart disease.

By finding any of these problems early, you can work with your doctor to treat symptoms or control problems through lifestyle changes and/or medication. The sooner you're able to find potential issues and act on them, the more you'll be able to lower your risk for heart disease, heart attack, or stroke.

Most common heart conditions

The most common heart conditions include:




Blood vessel disease, such as coronary artery disease (CAD)

When fatty plaques build up in your arteries, damaging your blood vessels and heart. This can lead to a heart attack, chest pain, or stroke.

  • Chest pain, chest tightness, chest pressure, and chest discomfort
  • Shortness of breath
  • Pain, numbness, weakness, or coldness in your legs or arms
  • Pain in the neck, jaw, throat, upper abdomen, or back

Heart rhythm problems, such as arrhythmias

Your heart may beat too fast, too slow, or irregularly

  • Fluttering in your chest
  • Racing heartbeat
  • Slow heartbeat
  • Chest pain or discomfort
  • Shortness of breath
  • Lightheadedness
  • Dizziness
  • Fainting or near fainting

Heart valve disease

Many things can damage your heart valves, leading to narrowing, leaking, or improper closing of the valves

  • Fatigue
  • Shortness of breath
  • Irregular heartbeat
  • Swollen feet or ankles
  • Chest pain
  • Fainting

Disease of the heart muscle

Different types of cardiomyopathy affect the heart differently, such as enlarging and thickening heart muscle, enlarged and weakened ventricles, or stiffened ventricles

  • Breathlessness with activity or at rest
  • Swelling of legs, ankles, and feet
  • Fatigue
  • Irregular heartbeats that feel rapid, pounding, or fluttering
  • Dizziness, lightheadedness, and fainting

Most of these conditions can be detected early by listening to your body and talking to your doctor if you have any concerns regarding your heart health. You should also work closely with your health care team to learn about things you can do to reduce your heart disease risk, such as lifestyle changes, medications, or screenings.

Heart disease risk factors

About half of all Americans have at least one of three key risk factors for heart disease: high blood pressure, high blood cholesterol, and smoking. However, other medical conditions and lifestyle choices can also put you at higher risk, such as:

  • Diabetes
  • Overweight and obesity
  • Unhealthy diet, including a diet high in saturated fats, trans fat, and cholesterol
  • Lack of physical activity
  • Excessive alcohol use

Heart disease can happen at any age for both men and women, but the risk increases as you get older. Family history of heart disease, including some genetic factors, can play a role in blood pressure, heart disease, and other heart conditions. However, it's also likely these people share common environments or other factors that may increase their risk.

Additional Resources

Florida native Eric Ruge lives by one rule: Do the right thing. His goal as a Medicare agent is helping people find the right Medicare coverage for their unique medical needs and budget. He believes everyone deserves the peace of mind they get knowing they made the right decision about their Medicare coverage. When he's not working, Eric enjoys spending time with family and friends, watching Tampa sports, and playing the occasional round of golf.


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