EKG (Electrocardiogram), 12-Lead with Interpretation
CPT 93000 is the global code for a 12-lead electrocardiogram, including both the tracing and physician interpretation. It is a quick, painless heart rhythm test done in under 10 minutes. Providers charge an average of $67.91, but Medicare pays only $15.36 (4.4x markup). With 6.7 million Medicare beneficiaries receiving this test, it is one of the most common cardiac procedures in the country.
CPT 93000 at a Glance
- Average provider charge: $67.91
- Medicare rate: $15.36
- Typical markup: 4.4x over Medicare rate
- Cash-pay range: $20 to $50
- Test duration: Under 10 minutes
- Includes: Tracing + interpretation
- Setting difference: Same rate, but hospitals add facility fee
- Beneficiaries (2023): 6.7 million
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How the Medicare Rate Is Calculated
Medicare values every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). For CPT 93000, the non-facility and facility Practice Expense RVUs are the same, so Medicare pays the same physician fee regardless of setting. Here is the math:
| Component | What It Covers | RVU |
|---|---|---|
| Work RVU | Physician time, skill, and judgment | 0.17 |
| Practice Expense RVU | Equipment, staff, supplies (EKG machine, electrodes) | 0.27 |
| Malpractice RVU | Professional liability insurance | 0.02 |
| Total RVU | 0.46 | |
| x $33.4009 | 2026 conversion factor | $15.36 |
Medicare Rate by State
Medicare adjusts the national rate based on your location using Geographic Practice Cost Indices (GPCIs). Because 93000 is a low-dollar code, the state variation is small in absolute terms (roughly $14 to $19), but the percentage spread is significant.
Medicare Rate by State (2026)
Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.
Sample State Rates
| State | Medicare Pays | Avg. Charge | Markup |
|---|---|---|---|
| Texas (Austin) | $15.82 | $67.91 | 4.3x |
| California (Los Angeles) | $17.02 | $67.91 | 4.0x |
| New York (Manhattan) | $17.58 | $67.91 | 3.9x |
| Florida (Fort Lauderdale) | $16.02 | $67.91 | 4.2x |
| Ohio | $14.58 | $67.91 | 4.7x |
| Mississippi | $13.94 | $67.91 | 4.9x |
| Arkansas | $13.77 | $67.91 | 4.9x |
| Alaska | $18.49 | $67.91 | 3.7x |
Rates shown use 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $67.91 is the 2023 national average from CMS utilization data. Actual charges vary by provider.
What Insured Patients Actually Pay for an EKG
An EKG is a low-cost test, so your out-of-pocket amount depends heavily on your plan design. If you have a copay plan with your deductible met, you may pay nothing extra (it is often bundled into the office visit copay). If your deductible is not met, you could owe the full negotiated rate.
| Your Situation | What You Likely Pay | How It Works |
|---|---|---|
| Copay plan (deductible met) | $0 to $25 | Often bundled into office visit copay, or small diagnostic copay |
| Coinsurance plan (deductible met) | $4 to $14 | 20% of negotiated rate ($20 to $70) |
| High-deductible plan (deductible NOT met) | $20 to $70 | Full negotiated rate until deductible is met |
| Medicare Part B | $3.07 | 20% of the Medicare-approved amount ($15.36) |
Common Billing Problems with EKGs
Routine EKG added to every annual physical
Some practices perform an EKG with every annual physical as a revenue add-on, even when it is not clinically indicated. The U.S. Preventive Services Task Force does not recommend routine EKG screening for low-risk adults. If you are healthy with no cardiac symptoms, ask whether the EKG is medically necessary before it is performed. Once the test is done, you will be billed.
Hospital facility fees on a $15 test
If your EKG is performed at a hospital outpatient department (including hospital-owned physician practices), the hospital adds a facility fee on top of the $15.36 physician fee. This facility fee can be $50 to $200, turning a simple test into a surprisingly expensive line item. If your doctor's office was recently acquired by a hospital, you may see this new charge appear.
Split billing: 93005 + 93010 instead of 93000
CPT 93000 is the global code covering both the tracing and interpretation. Some providers bill the tracing (93005) and interpretation (93010) as separate codes, which can result in a higher total charge. If you see both 93005 and 93010 on your bill, add up their charges and compare to what 93000 would have cost. The split billing is not necessarily wrong, but it sometimes costs more.
EKG billed during a wellness visit that should have been included
Medicare covers a one-time screening EKG as part of the "Welcome to Medicare" preventive visit within the first 12 months of Part B enrollment. If you are billed separately for an EKG during this initial visit, it may have been an error. For subsequent annual wellness visits, however, an EKG is not a covered preventive service and will be billed separately if performed.
Frequently Asked Questions
How much does an EKG cost without insurance?
An EKG (CPT 93000) typically costs $20 to $50 at most practices as a cash-pay price. The national average provider charge is $67.91, but many offices offer discounts for self-pay patients. Medicare pays only $15.36 for this test. The charges rarely justify a formal bill review, but watch for this test being bundled into a larger bill where it adds unnecessary cost.
What is the difference between CPT 93000, 93005, and 93010?
CPT 93000 is the "global" EKG code that includes both the tracing (technical component) and the physician interpretation. CPT 93005 covers only the tracing, and CPT 93010 covers only the interpretation. If billed separately as 93005 + 93010, the total may cost more than the single global 93000 code. Check your bill for this split billing pattern.
Should an EKG be included in my annual physical?
An EKG is not part of the standard annual wellness visit covered under the ACA. However, Medicare covers a one-time "Welcome to Medicare" screening EKG within the first 12 months of Part B enrollment. If your doctor orders an EKG during an annual physical, it will typically be billed separately and may apply to your deductible. The U.S. Preventive Services Task Force does not recommend routine EKG screening for low-risk adults.
Why was I charged so much for an EKG at the hospital?
Hospitals add a facility fee on top of the physician charge for an EKG. While the physician portion is the same $15.36 that Medicare pays in any setting, the hospital facility fee can add $50 to $200 or more, making a simple $15 test cost several hundred dollars at hospital outpatient departments. If possible, get your EKG at an independent office to avoid this added cost.
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