ABI Test Cost in 2026: Insurance, Medicare & How to Pay Less

How Much Does an ABI Test Cost?

If you're paying entirely out of pocket — meaning no insurance coverage at all — an ABI test in the United States typically costs between $150 and $400. The wide range reflects differences in:

Stethoscope and medical billing forms representing insurance coverage and diagnostic costs.

• Facility type: A hospital outpatient department generally charges more than a private vascular clinic or physician office due to hospital "facility fees"
• Geographic location: Tests in major metropolitan areas (New York, Los Angeles, Chicago) tend to cost more than in smaller cities or rural areas
• Scope of testing: A bilateral ABI (both legs) with multiple artery sites measured costs more than a unilateral (one leg) study
• Professional vs. technical components: The total bill often includes a "technical fee" (the test itself) plus a "professional fee" (the physician's interpretation). Both should be clarified upfront

CPT Codes Used for ABI Testing

CPT (Current Procedural Terminology) codes are the universal billing codes that identify specific medical procedures. Knowing the right codes empowers you to verify coverage with your insurer before the test. The codes most commonly used for ABI testing are:

When calling your insurance company, give them the CPT code 93922 for a standard ABI test and ask whether it's covered under your plan, what your deductible and co-pay would be, and whether a prior authorization is required.

Medicare Coverage for ABI Testing

Medicare's coverage of ABI testing is nuanced and frequently misunderstood. Here's the straight story:

When Medicare Covers the ABI Test

Medicare Part B (medical insurance) will cover the ABI test when a physician documents that it is medically necessary. This generally means you have:

• Documented signs or symptoms of PAD — such as leg pain with walking, claudication, non-healing wounds, or abnormal pedal pulses on physical exam
• A history of cardiovascular disease and new limb symptoms that warrant evaluation
• Risk factors (diabetes, smoking, hypertension) that the physician believes justify testing based on clinical judgment

When covered, Medicare typically pays 80% of the Medicare-approved amount after your Part B deductible is met. In 2026, the Part B deductible is $240 per year. Your supplemental insurance (Medigap) may cover the remaining 20%.

When Medicare Does NOT Cover the ABI Test

Medicare does not routinely cover the ABI test as a preventive screening for people who have no symptoms and no clinical indication. There is currently no National Coverage Determination (NCD) from CMS that mandates ABI coverage as a universal screening tool, even for high-risk groups. Coverage policies are partly determined at the regional level by Local Coverage Determinations (LCDs) set by Medicare Administrative Contractors (MACs) — meaning coverage rules can vary somewhat by state.

Medicare Advantage (Part C)

If you have a Medicare Advantage plan, coverage rules are set by the private insurer administering the plan. Some Medicare Advantage plans have more generous coverage than traditional Medicare for vascular screening. Call the number on your card and ask specifically about ABI test coverage.

Private Insurance Coverage

Most major private insurers — including Blue Cross Blue Shield, Aetna, UnitedHealthcare, Cigna, and Humana — will cover the ABI test when medically necessary. The process typically mirrors Medicare: your doctor must document a clinical indication, the test must be ordered (not self-referred), and the facility must be in-network.

Key Steps for Private Insurance Coverage

1. Verify in-network providers: Make sure the vascular lab where you'll have the test is in-network with your plan. An out-of-network lab can result in dramatically higher costs even when the test itself is covered.
2. Check for prior authorization requirements: Some plans require prior authorization (pre-approval) for vascular studies. Your ordering physician's office can typically handle this, but it's worth confirming.
3. Understand your deductible: If you haven't met your annual deductible yet, you'll likely pay the full negotiated rate for the test. This is not the same as the undiscounted "list price" — insurers negotiate rates that are often 30–60% lower than what uninsured patients pay.
4. Ask about the professional fee separately: The interpreting physician may bill separately from the facility where the test was performed. They may not be in-network even if the facility is — ask your insurer.

ABI Test Costs in Canada

In Canada's publicly funded healthcare system, the situation varies significantly by province:

• Ontario (OHIP): ABI testing ordered by a physician for medically necessary indications is covered by OHIP. Wait times vary by region — typically 2–8 weeks for a vascular lab appointment.
• British Columbia (MSP): Covered when ordered for medical indications. BC Health provides vascular labs at major hospitals and through some community diagnostic centers.
• Alberta (AHCIP): Covered for medically necessary indications. The Alberta Vascular Access Program coordinates access to vascular testing.
• Other Provinces: Generally covered under provincial health plans when medically indicated, but wait times and access vary.
• Private Pay in Canada: If you choose to pay privately for faster access, private vascular clinics in major Canadian cities typically charge CAD $200–$500 for an ABI test. This is out-of-pocket as provincial health plans don't reimburse private pay.

For a full guide to accessing PAD care in Canada, including provincial health resources and Heart & Stroke Foundation support programs, visit our PAD in Canada resource page.

How to Reduce Your Out-of-Pocket Cost

If you're facing out-of-pocket costs for an ABI test, here are practical strategies to reduce what you pay:

• Use a federally qualified health center (FQHC): These community health centers serve patients on sliding-fee scales based on income. Many offer vascular screening services. Find one at findahealthcenter.hrsa.gov.
• Check if your primary care doctor can do it in-office: A basic ABI can sometimes be done in a primary care office for a lower facility fee than a hospital outpatient lab.
• Timing with your deductible: If you've already met your annual deductible (more likely in the second half of the year), your out-of-pocket cost is typically just your co-insurance percentage, not the full price.
• Ask about financial assistance programs: Most hospitals have charity care or financial assistance programs for uninsured or underinsured patients. Ask for the billing department's financial counselor.
• Check GoodRx Health or MDsave: These platforms sometimes offer pre-negotiated rates for diagnostic tests at specific facilities, which can be lower than standard uninsured rates.
• Look for community health screenings: Some hospital systems, the American Heart Association, and community organizations periodically offer free or low-cost vascular screening events. Check your local hospital's event calendar.

Questions to Ask Before Your ABI Test

Before your appointment, call the facility and ask:

• "Is your facility in-network with [my insurance plan]?"
• "What CPT codes will be billed for my ABI test?"
• "Is there a separate professional fee from the interpreting physician, and is that doctor also in-network?"
• "What is the self-pay price if my insurance doesn't cover this?"
• "Do I need to bring a physician order/referral?"
• "Is there parking/transportation assistance if needed?"

Also call your insurer before the appointment and ask: "Is CPT 93922 covered under my plan for an outpatient vascular study when medically indicated? What is my expected cost-sharing?"