CalciumCT.com

Does insurance or Medicare cover a calcium score test?

What Medicare, three large insurers and state law say about CPT 75571, how HSA and FSA money works, and what changes when you pay cash while insured.

The short answer. Original Medicare does not pay for a calcium scan done as a screening test. Private plans vary: some cover it for people who meet their risk criteria, and some not at all. In at least 4 states, a law makes some plans cover it. Paying cash is allowed whether or not you are insured, and the median self-pay price recorded in this directory is $127.50.

This page explains public rules. It is not a coverage decision: your plan's documents decide what it pays, and the call at the end is how to find out.

Original Medicare

Medicare does not pay for a test done as a check-up unless it is one of the screening services Medicare specifically covers. The Social Security Act bars payment for services that are “not reasonable and necessary for the diagnosis or treatment of illness or injury” and for “routine physical checkups” (§ 1862(a), 42 U.S.C. 1395y). Medicare’s regulations then list the screening tests that are exceptions, such as screening mammograms and colorectal cancer screening (42 CFR 411.15(a)). A coronary calcium scan is not on that list. The “cardiovascular disease screening” Medicare does cover is a blood test for cholesterol, lipids and triglycerides, once every five years (Medicare.gov; 42 CFR 410.17).

There is no national coverage determination for calcium scoring. The general CT rule covers a scan only when it is reasonable and necessary for the individual patient (NCD 220.1). The regional contractors that process Medicare claims fill that gap, and the cardiac CT rules of four of them say no:

The route by which Medicare adds a preventive service on its own runs through the U.S. Preventive Services Task Force: the service needs a grade of A or B (§ 1861(ddd), 42 U.S.C. 1395x). The Task Force’s current recommendation, from 2018, grades the calcium score I: “the current evidence is insufficient to assess the balance of benefits and harms” (USPSTF). It is reviewing the question again; the research plan for that review was finalized on September 26, 2024 (USPSTF).

At the facility, you may be asked to sign an Advance Beneficiary Notice before the scan. A provider gives one when it thinks Medicare will not pay, and it asks you to choose whether a claim is sent anyway; Medicare.gov explains the choices (Medicare.gov). Either way, expect to pay for the scan yourself.

Medicare Advantage

A Medicare Advantage plan has to cover everything Original Medicare covers, and it may cover more as a supplemental benefit (42 CFR 422.101; 42 CFR 422.102). So whether a calcium scan is covered depends entirely on your plan. We have not found a plan document we could cite that lists one, so we name no plans here. Search your plan’s Evidence of Coverage for “calcium” or “75571”, or ask the plan.

Private insurance

The federal rule that makes preventive care free under most private plans applies to services the Task Force grades A or B (42 U.S.C. 300gg-13). The calcium score’s grade is I, so no plan has to cover it at no cost, and each insurer writes its own policy. Three show how far apart those policies are:

These are summaries of each insurer’s medical policy, not of your plan. Your plan document can add exclusions, and an employer plan can differ from the insurer’s standard one.

A “diagnostic” order does not usually change the answer. Medicare’s contractors treat a calcium score billed on its own as a screening service, and Cigna’s guideline does not support the scan for people with symptoms. The insurers above that cover it do so mainly as a risk check for people without symptoms.

Covered is not the same as free. Because the free-preventive-care rule does not apply, a covered scan can still count against your deductible and coinsurance. The average deductible for single coverage at work was $1,886 in 2025, and 34% of covered workers had one of $2,000 or more (KFF 2025 Employer Health Benefits Survey, October 22, 2025). Until yours is met, you would usually pay the plan’s negotiated rate for the scan, which is why it is worth asking for both numbers before you book.

State laws

We have found 4 states whose laws require some health plans to cover a calcium scan, and read each law in the statute’s own text. There may be others. If you know of one, tell us.

Texas

Who: Men older than 45 and women older than 55, in both cases younger than 76, who have diabetes or a Framingham coronary-risk score of intermediate or higher.

What the plan must cover: Up to $200 toward one of two tests every five years: a CT scan measuring coronary artery calcification, or a carotid ultrasound. The test has to be done by a laboratory certified by an organization the insurance commissioner recognizes (28 Tex. Admin. Code § 21.4301 names the American College of Radiology, the Intersocietal Accreditation Commission, and certifiers recognized by CMS).

Which plans: State-regulated health plans that already cover screening procedures, including HMOs and small-employer plans. Limited-benefit plans and a few other plan types are excepted.

The law: Tex. Ins. Code ch. 1376, enacted 2009, H.B. 1290. It applies to plans issued or renewed on or after January 1, 2010. Last read October 2, 2026.

In our data: we list 105 Texas facilities, 22 of which have a listed price. Every one of those prices is at or under the $200 of coverage the law requires. That $200 is the least coverage an eligible plan must provide, not a limit on what a facility may charge.

New Mexico

Who: People aged 45 to 65 whose clinician judges them at intermediate risk of coronary heart disease using an evidence-based ten-year risk calculator. A repeat scan is covered every five years, and only after a score of zero.

What the plan must cover: A heart artery calcium scan, a CT scan measuring coronary artery calcium. The law sets no dollar amount.

Which plans: Group health plans, group HMO contracts and group nonprofit health plans other than small-group plans; public-employee plans under the Health Care Purchasing Act; and Medicaid. Individual and small-group policies are not included.

The law: Laws 2020, ch. 79 (NMSA 1978 §§ 13-7-24, 27-2-12.31, 59A-23-7.16, 59A-46-50.5, 59A-47-45.7), enacted 2020, H.B. 126. It applies to plans issued or renewed on or after January 1, 2021. Last read October 2, 2026.

In our data: we list 9 New Mexico facilities, 1 of which has a listed price.

Connecticut

Who: The law sets no age or risk test of its own.

What the plan must cover: Coronary calcium scans, defined as a CT scan of the heart that looks for calcium deposits in the heart arteries. The law sets no dollar amount and does not say the scan must be free of cost sharing.

Which plans: Individual and group health insurance policies issued or renewed in Connecticut, including HMO contracts. For a high-deductible plan used with a health savings account, it applies only as far as federal law allows.

The law: Conn. Gen. Stat. §§ 38a-492x, 38a-518x, enacted 2024, Public Act 24-19. It applies to plans issued or renewed on or after January 1, 2025. Last read October 2, 2026.

In our data: we list 10 Connecticut facilities, 3 of which have a listed price.

Maryland

Who: People with at least three of: diabetes, high blood pressure, high cholesterol, or a family history of premature coronary artery disease. Coverage follows the American College of Cardiology’s most recent guidelines.

What the plan must cover: Calcium score testing. The law sets no dollar amount.

Which plans: Insurers, nonprofit health service plans and HMOs, for individual and group policies issued or renewed in Maryland; also Maryland Medicaid and its managed care organizations.

The law: Md. Code, Ins. § 15-861 (2025 Md. Laws ch. 684), enacted 2025, H.B. 666. It applies to plans issued or renewed on or after January 1, 2026. Last read October 2, 2026.

In our data: we list 61 Maryland facilities, 15 of which have a listed price.

A state insurance law reaches only the plans that state regulates. Self-funded employer plans are governed by federal law instead and are exempt (Texas Department of Insurance). If your coverage comes through a large employer, ask whether the plan is “fully insured” or “self-funded” before counting on a state law.

HSA and FSA

The IRS counts the cost of “diagnostic tests” as a medical expense even when you are not ill (Publication 502), and an HSA can pay for medical care as the tax code defines it (Publication 969). A calcium scan ordered by a clinician fits that description. Whether a particular payment qualifies is your account administrator’s decision, so keep the receipt and the order.

Of the 1272 listings here, 19 say HSA or FSA funds can be used, and for the other 1253 we have not established it, so those listings say nothing either way. Whether the desk takes the card itself is a separate question, so ask when you call, or search by ZIP to see which listings give an answer.

Paying cash when you have insurance

You can. Federal price-estimate rules treat you as “self-pay” when you have employer, individual or federal-employee health coverage but choose not to have a claim submitted to it, which gives you the same right to a good faith estimate as someone without insurance (45 CFR 149.610):

The dispute process behind the estimate starts only when a bill is at least $400 more than the estimate, and must be started within 120 days of receiving the bill (45 CFR 149.620). Of the 228 self-pay prices in this directory, 225 are below $400: less than the overcharge the process needs before it applies. For a scan at these prices, the written estimate itself is the protection that matters.

If you pay in full yourself, you can also ask the facility not to send information about the scan to your health plan for payment purposes, and it has to agree unless a law requires the disclosure (45 CFR 164.522(a)(1)(vi)).

The deductible catch. A payment your plan never sees does not count toward your deductible unless your plan or your state has a way to credit it. Texas does, for PPO plans issued or renewed since January 1, 2024: the insurer must credit a payment you made directly to a provider toward your deductible and out-of-pocket maximum when the service is covered and medically necessary, no claim was filed, and you paid less than the average discounted rate the plan pays its in-network providers (Tex. Ins. Code § 1301.140). The insurer has to explain on its website how to claim the credit.

The call to make before you book

To your plan:

  1. “Is CPT 75571 covered for me, and under which policy?” Ask for the policy name or number so you can read the criteria yourself.
  2. “Does it need prior authorization?”
  3. “With my deductible and coinsurance, what would I pay?”
  4. If the plan is through work: “Is it fully insured or self-funded?” That decides whether a state law applies.

To the facility: “What is your self-pay price for CPT 75571, including the radiologist’s read?” Ask for the good faith estimate in writing, then choose the lower number. Recorded prices and what drives them are on the cost page; every listing is in the ZIP finder.

If you have symptoms such as chest pain, this is not a test to shop for on price. Talk to a clinician now.

Sources

We last read every source below on . Each state law above also gives the day it was last read.

This page is general information, not legal, tax or insurance advice. How we research, date and correct pages like this one is in our editorial standards.

Last updated .