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Abstract Low- to moderate-intensity ultrasound (US) technologies are increasingly being used to non-invasively modulate biological function in both clinical and laboratory settings. Realizing the full potential of these approaches requires a detailed mechanistic understanding of how ultrasound interacts with living cells. Here, we developed a well-controlled experimental platform to expose adherent cells to ultrasound stimulation while monitoring cellular activation via calcium imaging. We show that cell activation is dependent on cell type and identify NIH3T3 fibroblasts as a particularly robust responder. Our findings indicate that acoustic streaming is the primary mechanism underlying ultrasound-induced activation in our in vitro experiments. Surprisingly, the investigation of calcium dynamics revealed that the observed cytoplasmic calcium elevation originates predominantly from intracellular stores rather than extracellular influx, with membrane ion channels not contributing directly to the response. Notably, the biomechanical property of the cell-cortex emerges as a critical determinant of the cells’ sensitivity to ultrasound. Overall, our results provide clear evidence that the underlying mechanistic response involves external and internal factors that modulate the ultrasound-cell interaction and highlight important mechanistic considerations for ultrasound-based strategies aimed at cellular stimulation.