EECP Therapy Cost
Is
It Covered by Insurance? How much does a full course really cost?
A patient-friendly guide to EECP therapy
network status
The short answer is that EECP cost varies
The final amount depends on the treatment course, insurer and provider.
CLINICAL NEED
Why EECP therapy is recommended
Whether plan criteria are met
Deductible, copay or coinsurance
There is no safe universal quote until benefits and medical-necessity requirements are checked.
A
standard EECP course usually totals 35 hours
Many programmes use one-hour outpatient sessions over several weeks.
35 sessions × the negotiated or self-pay session rate
Some clinical schedules differ, but the total course commonly remains 35 treatment hours.
What can self-pay EECP therapy cost?
Published figures vary by clinic, location and what the package includes.
PUBLISHED REFERENCE POINT About $4,880
Average EECP cost used in a 2015 U.S. costeffectiveness study.
Treatment sessions
Clinical assessment or testing
Provider and facility fees
Follow-up evaluation
Historical research figure — not a current quote.
Ask the clinic for a written, itemised estimate before treatment begins.
Insurance may cover EECP for qualifying patients
Coverage is usually tied to a specific diagnosis and documented criteria.
Medicare
CMS recognises external counterpulsation under code G0166, with coverage centred on severe, disabling chronic stable angina when requirements are met.
Commercial plans
Many insurers publish medical-necessity criteria. Requirements can include Class III or IV stable angina, failed medical therapy and limited revascularisation options.
Other uses
Coverage for conditions outside plan criteria may be denied or treated as investigational. Never assume approval based only on a clinician recommendation.
Coverage is plan-specific and never guaranteed.
The insurance decision usually follows this path
Confirm authorisation before the first EECP therapy session.
Diagnosis documented Clinical notes and angina class
A prior-authorisation denial can sometimes be appealed with additional documentation.
Approval and patient share confirmed
Get reference number in writing
What you may still pay after approval
Insurance coverage does not always mean zero out-of-pocket cost.
DEDUCTIBLE Amount you pay before benefits begin COPAY Fixed charge for each covered visit
COINSURANCE Percentage of the allowed amount OUT-OF-NETWORK Higher share or no benefit under some plans
Multiply any per-visit responsibility by the number of approved sessions.
Ask these questions before you start
A short benefits check can prevent expensive surprises.
? ? Is EECP therapy covered for my diagnosis? ? ? Do I need prior authorisation?
? Is this clinic in network?
? How many sessions are approved? ? ? What are my deductible and coinsurance? ? ? Are tests or assessments billed separately?
Record the representative’s name, date and confirmation number.