Medicare Part B does cover a CT coronary angiogram when your doctor orders it to diagnose a suspected heart condition and the test is medically necessary. In 2026, the Medicare-approved amount runs about $517 at a freestanding imaging center and $681 at a hospital outpatient department. After the $283 Part B deductible, you pay 20% of whichever approved amount applies, so your share is roughly $103 to $136 depending on where the scan is done.
Coverage is not automatic. Because there is no National Coverage Determination specific to coronary CT angiography, the clinical rules your claim has to meet are set regionally by the Medicare Administrative Contractor that processes claims in your state, through Local Coverage Determinations. What qualifies in one region may be scrutinized more heavily in another.
When Medicare Will Pay for the Scan
The general standard across contractors is the same: your doctor has to show the scan will produce new, clinically useful information that changes how your condition is managed. Most LCDs approve the test for patients who have symptoms and fall into an intermediate pre-test probability of coronary artery disease, roughly a 10% to 90% estimated risk.
Within that range, two situations are the most common approvals:
- Stable chest pain after an earlier non-invasive test (such as a stress echocardiogram or perfusion study) came back inconclusive, unreadable, or could not be performed because of a medical contraindication.
- Acute chest pain with a normal EKG and normal cardiac enzymes, where the immediate risk is low enough that an invasive catheterization is not warranted.
Patients with known coronary artery disease may also be approved for a repeat scan when new or worsening symptoms suggest the disease has progressed. There is no fixed frequency limit, but every scan has to independently justify itself. If a contractor decides the test would not add anything beyond a recent one, it will be denied no matter how much time has passed.
What Medicare Won’t Cover
A CT coronary angiogram is not covered as a screening test for people without symptoms. It also will not be approved solely for general cardiovascular risk scoring or for measuring coronary calcium. Ordering the scan to “see what’s there” in a patient who feels fine is the fastest route to a denial. Your doctor’s documentation needs to name the symptoms, the relevant history, and the results of any prior workup.
What You’ll Actually Pay in 2026
Two things drive your out-of-pocket cost: whether you’ve met your Part B deductible for the year, and where you get the scan.
You first pay the annual Part B deductible of $283. After that, Medicare pays 80% of the approved amount and you pay the remaining 20% as coinsurance. This 80/20 split is set by federal law for Part B diagnostic services.
Freestanding Center vs. Hospital Outpatient
The same scan (CPT code 75574) has two different approved amounts in 2026. At an ambulatory surgical center or freestanding imaging facility, the national average is $517. At a hospital outpatient department, it’s $681. The whole difference is the facility fee: $192 at a freestanding center versus $356 at a hospital outpatient department.
Your 20% coinsurance moves with that. Roughly $103 at a freestanding center, about $136 at a hospital outpatient department, once your deductible is satisfied. If it isn’t, you’ll owe the full approved amount up to $283 first, then 20% of the rest. When your doctor gives you a choice of facility, picking a freestanding center is one of the simplest ways to lower the bill.
Assignment and Excess Charges
If your provider doesn’t accept Medicare assignment, they can bill up to 15% above the approved amount. That extra, called the limiting charge, is entirely on you. Medicare still pays 80% of the approved amount, not the higher billed amount. Most imaging facilities accept assignment for diagnostic tests, but confirm it before you schedule.
How Medigap Changes the Math
A Medigap policy can wipe out most or all of your cost-sharing on a scan this expensive.
Plan G covers 100% of the Part B coinsurance and 100% of any excess charges from non-participating providers. A high-deductible version of Plan G is available in some states and requires you to pay $2,950 out of pocket in 2026 before the policy pays.
Plan N covers 100% of the Part B coinsurance for most services but does not cover excess charges. On a CTCA, either plan effectively eliminates the 20% coinsurance. The practical difference shows up only if you use a non-participating provider, where Plan G shields you from excess charges and Plan N doesn’t.
If You Have Medicare Advantage
Medicare Advantage plans must cover every medically necessary service Original Medicare covers, including this one. How they administer it is where the differences show up.
Most plans require prior authorization for high-cost imaging. Your doctor’s office submits clinical records, and the plan decides before the scan is done. Skipping that step, even when the test is clearly necessary, can leave you responsible for the full cost. Under a 2024 CMS rule, plans must follow the same coverage standards as Original Medicare, including any applicable Local Coverage Determinations, and an approved prior authorization has to stay valid for the full course of treatment.
Network rules also matter. HMO plans generally cover non-emergency care only in-network. PPOs allow out-of-network use but charge more for it. Before scheduling, call your plan to confirm the prior authorization requirement, verify that both the imaging facility and the reading physician are in-network, and ask what your copay or coinsurance will be. Advantage plans often use flat copays rather than the 20% structure, and the amount varies widely.
If Your Doctor Hands You an ABN
When your doctor thinks Medicare is likely to deny the claim, they’re required to give you an Advance Beneficiary Notice of Noncoverage (form CMS-R-131) before the scan. It explains why the claim may be denied and gives you three options: go ahead and accept financial responsibility if Medicare denies it, go ahead and have the claim filed so you can appeal a denial, or cancel the test.
An ABN is a flag, not a verdict. If Medicare approves the claim anyway, you pay only your normal cost-sharing. If it denies, you owe the bill. ABNs come up most often in borderline situations, such as a repeat scan sooner than a contractor typically expects or symptoms that don’t clearly fit an LCD’s criteria.
Appealing a Denial
A denial doesn’t have to end the matter. Under Original Medicare, you have 120 days from the date you receive the denial notice to file a Level 1 redetermination. Medicare treats the notice as received five calendar days after its date, so your clock effectively starts then.
The request goes in writing to the Medicare Administrative Contractor that processed the claim. You can use CMS Form 20027 or write a letter with your name, Medicare number, the service and date at issue, and why you disagree. The single most useful thing you can attach is a letter from your doctor explaining the medical necessity: your symptoms, prior test results, and the clinical question the CTCA was meant to answer. Claims denied for thin documentation often succeed once the right records are added. There’s no minimum dollar amount to file, and most contractors accept electronic submissions.
If the redetermination upholds the denial, four more levels are available, starting with reconsideration by an independent contractor and ending, if it goes that far, in federal court. Most beneficiary disputes over diagnostic imaging are resolved at the first or second level. For a Medicare Advantage denial, your plan runs its own internal appeal first, and the denial letter will spell out that plan’s deadlines and instructions.