Medicare Part B covers Ultrasound at 80% after the Part B deductible. Here's the full cost-sharing breakdown, admission status rules, and Medicare Advantage differences.
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Does Medicare Cover Ultrasound? (2026)
Yes. Medicare Part B covers medically necessary Ultrasound at 80% after the Part B deductible. You pay 20% coinsurance with no annual maximum under Original Medicare.
Quick answer:
- Medically necessary Ultrasound: Part B — 80% after $257 deductible
- Your share: 20% coinsurance
- Prior authorization: Not required under Original Medicare; varies under Medicare Advantage
What Medicare Covers
Medicare Part B covers ultrasound when:
The same ultrasound can be one bill or two — and the radiologist can be out-of-network even when the facility isn't.
Your personalized cost report includes:
- ✓ Why a facility splits into a technical bill and a separate radiologist bill (and an office bills one global fee)
- ✓ How the radiologist who reads your images can be out-of-network even at an in-network facility
- ✓ Why a hospital outpatient department costs far more than an independent imaging center
- ✓ How a complete vs. limited study changes the price — and the questions to ask first
- ✓ A real patient billing breakdown, line by line
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- Ordered by a Medicare-enrolled physician for a documented medical reason
- Performed at a Medicare-enrolled facility or physician office
- The physician and radiologist/cardiologist are both Medicare-enrolled
Ultrasound is covered as a diagnostic service — not preventive. There is no $0 screening ultrasound benefit under Medicare.
Cost Under Original Medicare
| Situation | What you pay |
|---|---|
| Before Part B deductible met ($257) | 100% of allowed amount |
| After Part B deductible | 20% coinsurance |
| With Medigap supplement | Supplement pays the 20% coinsurance |
Two Medicare Claims
Medicare receives two separate claims for a ultrasound:
- Technical component: Facility or equipment billing at 80% of allowed amount
- Professional component: The radiologist reads and interprets; billed separately at 80%
Both must be from Medicare-enrolled providers. If a provider does not accept Medicare assignment, they can balance bill you up to 15% above the Medicare allowed amount (the "limiting charge").
Medicare Advantage
Medicare Advantage plans may require prior authorization for Ultrasound even though Original Medicare does not. Check your MA plan's prior authorization requirements before scheduling.
Related Cost Information
Related: Is an Ultrasound covered by insurance? → · Ultrasound billing surprises →
The same ultrasound can be one bill or two — and the radiologist can be out-of-network even when the facility isn't.
Your personalized cost report includes:
- ✓ Why a facility splits into a technical bill and a separate radiologist bill (and an office bills one global fee)
- ✓ How the radiologist who reads your images can be out-of-network even at an in-network facility
- ✓ Why a hospital outpatient department costs far more than an independent imaging center
- ✓ How a complete vs. limited study changes the price — and the questions to ask first
- ✓ A real patient billing breakdown, line by line
Free for patients — takes 30 seconds to get.
We'll email it to you immediately. No account required, no spam.
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About the Author
John Caruso, FSA, MAAA
Healthcare actuary with 20+ years of experience in insurance pricing, medical billing systems, and healthcare cost analytics.
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