Reimbursement information for diagnostic

ultrasound procedures completed with a

Vscan™ Family ultrasound device
1

2024

gehealthcare.com/reimbursement
Table of Contents

Current Procedural Terminology (CPT) coding.............................. 3

Anesthesiology................................................................................... 3

Ultrasound Guidance of Regional Anesthesia in the ASC.............. 4

Echocardiograph................................................................................ 5

Emergency Medicine......................................................................... 5

Endocrinology.................................................................................... 5

Musculoskeletal Applications — Ultrasound Services................... 6

Musculoskeletal Applications — Procedures.................................. 6

Obstetrics and Gynecology............................................................... 7

Pain Management.............................................................................. 8

Pulmonary Medicine......................................................................... 9

Surgery................................................................................................ 9

Vascular Access.................................................................................. 10

Vascular Surgery................................................................................ 10

Billing criteria..................................................................................... 11

Billing requirements for pocket-sized ultrasound device............. 11

Qualifications of personnel.............................................................. 11

Documentation requirements......................................................... 11

Coverage policies............................................................................... 12

Modifiers............................................................................................. 12

ICD-10-CM diagnosis coding............................................................. 12

Limited vs. complete ultrasound..................................................... 12

Other considerations......................................................................... 12

Disclaimer........................................................................................... 13
This overview addresses coding, coverage, and payment for diagnostic ultrasound procedures performed with pocket-sized ultrasound visualization
tools in the general practitioner and family practice physician office settings.2 A pocket-sized ultrasound is a small, battery-powered device that
fits in a physician’s pocket and is intended for use in performing focused, non-invasive diagnostic ultrasound imaging, to assist physicians with
real-time, point-of-care visual information at the bedside. While this advisory focuses on Medicare program policies, these policies may also be
applicable to selected private payers throughout the country.

Current Procedural Terminology (CPT®)3 coding, definitions, and Medicare reimbursement

The following tables provide CPT coding and 2024 Medicare national average reimbursement for the physician facility and non-facility settings
of care. Payment will vary by geographic location. Physician Non-facility values are shown as the Global value along with the Professional
Component (PC –26) and Technical Component (TC).

New CPT code A2 — Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Updated CPT description G2 — Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
J8 — Device-intensive procedure; paid at adjusted rate.
N1 — Packaged service/item; no separate payment made.
P3 — Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS non-facility PE RVUs; payment based on MPFS non-facility
PE RVUs.
Z2 — Radiology or diagnostic service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative
payment weight.
Chart title Z3 — Radiology or diagnostic service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS non-facility
PE RVUs.

Anesthesiology
ASC
Physician Non-facility APC APC
CPT Description payment ASC payment 6
payment** 4 code 5 payment 5
indicator

Global: $57.92
Ultrasonic guidance for needle placement (e.g. biopsy, aspiration, Packaged. Packaged. No
76942 Professional: $29.63 N1
injection, localization device), imaging supervision and interpretation No extra payment. extra payment.
Technical: $28.29
Ultrasonic guidance for vascular access requiring ultrasound
evaluation of potential access sites, documentation of selected Global: $38.28
Packaged. Packaged. No
76937 vessel patency, concurrent real-time ultrasound visualization of Professional: $13.65 N1
No extra payment. extra payment.
vascular needle entry, with permanent recording and reporting Technical: $24.63
(list separately in addition to code for primary procedure)

ASC
Non-facility Facility APC APC
CPT Description payment ASC payment
payment* payment* code payment
indicator

Injection(s), anesthetic agent(s) and/or steroid; greater occipital

64405 $75.56 $52.59 5441 $282.20 P3 $36.95
nerve

Injection(s), anesthetic agent(s) and/or steroid; brachial plexus,

64415 $133.82 $68.57 5443 $868.45 A2 $472.76
including imaging guidance, when performed

Injection(s), anesthetic agent(s) and/or steroid; axillary nerve,

64417 $160.11 $63.25 5443 $868.45 A2 $472.76
including imaging guidance, when performed

64418 Injection(s), anesthetic agent(s) and/or steroid; suprascapular nerve $86.22 $54.92 5442 $658.90 P3 $45.60

Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve,

64420 $97.87 $57.59 5442 $658.90 A2 $358.69
single level

3
Anesthesiology cont.
ASC
Non-facility Facility APC APC
CPT Description payment ASC payment
payment payment code payment
indicator

Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve,

64421 each additional level (list separately in addition to code for primary $33.29 $24.63 5443 $868.45 A2 $472.76
procedure)

Injection(s), anesthetic agent(s) and/or steroid; ilioinguinal,

64425 $110.52 $53.93 5442 $658.90 P3 $73.90
iliohypogastric nerves

"Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve,

64445 $158.45 $71.24 5442 $658.90 P3 $107.51
including imaging guidance, when performed

"Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve,

64446 continuous infusion by catheter (including catheter placement), n/a $74.23 5443 $868.45 G2 $472.76
including imaging guidance, when performed

"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve,

64447 $115.84 $62.25 5442 $658.90 P3 $67.57
including imaging guidance, when performed

"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve,

64448 continuous infusion by catheter (including catheter placement), n/a $70.90 5443 $868.45 J8 $646.31
including imaging guidance, when performed

"Injection(s), anesthetic agent(s) and/or steroid; other peripheral

64450 $75.23 $41.61 5442 $658.90 P3 $47.27
nerve or branch

Ultrasound Guidance of Regional Anesthesia in the ASC

ASC
Professional APC APC
CPT Description payment ASC payment
payment code payment
indicator

Ultrasonic guidance for needle placement (e.g. biopsy, aspiration, injection, Packaged. Packaged. No
76942 $29.63 N1
localization device), imaging supervision and interpretation No extra payment. extra payment.

Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, including imaging

64415 $68.57 5443 $868.45 A2 $472.76
guidance, when performed

Injection(s), anesthetic agent(s) and/or steroid; axillary nerve, including imaging

64417 $63.25 5443 $868.45 A2 $472.76
guidance, when performed

64418 Injection(s), anesthetic agent(s) and/or steroid; suprascapular nerve $54.92 5442 $658.90 P3 $45.60

64420 Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level $57.59 5442 $658.90 A2 $358.69

Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, each additional

64421 $24.63 5443 $868.45 A2 $472.76
level (list separately in addition to code for primary procedure)

64425 Injection(s), anesthetic agent(s) and/or steroid; ilioinguinal, iliohypogastric nerves $53.93 5442 $658.90 P3 $73.90

Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, including imaging

64445 $71.24 5442 $658.90 P3 $107.51
guidance, when performed
Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion
64446 by catheter (including catheter placement), including imaging guidance, when $74.23 5443 $868.45 G2 $472.76
performed
Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging
64447 $62.25 5442 $658.90 P3 $67.57
guidance, when performed
Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion
64448 by catheter (including catheter placement), including imaging guidance, when $70.90 5443 $868.45 J8 $646.31
performed

64450 Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch $41.61 5442 $658.90 P3 $47.27

4
Echocardiograph
ASC
Physician Non-facility APC APC
CPT Description payment ASC payment
payment code payment
indicator

Global: $155.12
Transthoracic echocardiography for congenital cardiac anomalies, Not listed on
93304 Professional: $34.95 5524 $525.63
follow-up or limited ASC fee schedule.
Technical: $120.17

Emergency Medicine
ASC
Professional APC APC
CPT Description payment ASC payment
payment code payment
indicator

Packaged. No
76604 Ultrasound, chest (includes mediastinum), real-time with image documentation $26.63 5522 $104.75 N1
extra payment.

Ultrasound, abdominal, real-time with image documentation; limited

76705 $27.30 5522 $104.75 Z2 $57.02
(e.g. single organ, quadrant, follow-up)

Ultrasound retroperitoneal (e.g. renal, aorta, nodes), real-time with image Packaged. No
76775 $26.96 5522 $104.75 N1
documentation; limited extra payment.
Ultrasound, pregnant uterus, real-time with image documentation, limited
Packaged. No
76815 (e.g. fetal heart beat, placental location, fetal position and/or qualitative amniotic $30.29 5522 $104.75 N1
extra payment.
fluid volume), one or more fetuses
Ultrasound, pelvic (non-obstetric), real time with image documentation; limited or
76857 $22.97 5522 $104.75 Z3 $31.63
follow-up (e.g. for follicles)

Ultrasonic guidance for vascular access requiring ultrasound evaluation of

potential access sites, documentation of selected vessel patency, concurrent real- Packaged. Packaged. No
76937 $13.65 N1
time ultrasound visualization of vascular needle entry, with permanent recording No extra payment. extra payment.
and reporting (list separately in addition to code for primary procedure)
Ultrasonic guidance for needle placement (e.g. biopsy, aspiration, injection Packaged. Packaged. No
76942 $29.63 N1
localization device), imaging supervision and interpretation No extra payment. extra payment.

Echocardiography, transthoracic, real-time with image documentation (2D), Not listed on

93308 $24.30 5523 $233.47
includes M-mode recording, when performed, follow-up or limited study ASC fee schedule.

Endocrinology
ASC
Physician Non-facility APC APC
CPT Description payment ASC payment
payment code payment
indicator

Global: $110.18
Ultrasound, soft tissues of head and neck (e.g. thyroid, parathyroid, Packaged. No
76536 Professional: $26.30 5522 $104.75 N1
parotid), real-time with image documentation extra payment.
Technical: $83.88
Global: $57.90
Ultrasonic guidance for needle placement (e.g. biopsy, aspiration, Packaged. Packaged. No
76942 Professional: $29.63 N1
injection, localization device), imaging supervision and interpretation No extra payment. extra payment.
Technical: $28.29

5
Endocrinology cont.
ASC
Non-facility Facility APC APC
CPT Description payment ASC payment
payment payment code payment
indicator

Fine needle aspiration biopsy; including ultrasound guidance;

10005 $134.15 $71.90 5071 $670.36 G2 $364.93
first lesion

Fine needle aspiration biopsy, including ultrasound guidance;

Packaged. Packaged. No
10006 each additional lesion (list separately in addition to code for primary $59.92 $49.27 N1
No extra payment. extra payment.
procedure)

60100 Biopsy, thyroid, percutaneous core needle $109.52 $75.23 5071 $670.36 P3 $51.93

Musculoskeletal Applications — Ultrasound Services

ASC
Physician Non-facility APC APC
CPT Description payment ASC payment
payment code payment
indicator

Global: $53.59
Ultrasound, complete joint (i.e. joint space and periarticular soft
76881 Professional: $42.61 5522 $104.75 Z3 $21.97
tissue structure(s)) real-time with image documentation
Technical: $10.99
Ultrasound, limited, joint or other nonvascular extremity structure(s) Global: $63.25
(e.g. joint space, periarticular tendon(s), muscle(s), nerve(s), other Packaged. No
76882 Professional: $32.29 5522 $104.75 N1
soft tissue structure(s), or soft tissue mass[es]) real-time with image extra payment.
documentation Technical: $30.96

Global: $57.92
Ultrasonic guidance for needle placement (e.g. biopsy, aspiration, Packaged. Packaged. No
76942 Professional: $29.63 N1
injection, localization device), imaging supervision and interpretation No extra payment. extra payment.
Technical: $28.29

Ultrasound, nerve(s) and accompanying structures throughout their Global: $71.24

Not listed on
76883 entire anatomic course in one extremity, comprehensive, including Professional: $56.92 5522 $104.75
ASC fee schedule.
real-time cine imaging with image documentation, per extremity Technical: $14.31

Musculoskeletal Applications — Procedures that include ultrasound guidance

ASC
Non-facility Facility APC APC
CPT Description payment ASC payment
payment payment code payment
indicator

Injection, therapeutic (e.g. local anesthetic, corticosteroid), carpal

20526 $82.55 $56.59 5441 $282.20 P3 $45.60
tunnel
Injection, enzyme (e.g. collagenase), palmar fascial cord (i.e.
20527 $87.88 $65.58 5441 $282.20 P3 $48.27
Dupuytren's contracture)
Injection(s) single tendon sheath, or ligament, aponeurosis (e.g.
20550 $57.92 $38.60 5441 $282.20 P3 $29.62
plantar “fascia”)

20551 Injection(s); single tendon origin/insertion $57.59 $38.28 5441 $282.20 P3 $29.62

20552 Injection(s), single to multiple trigger point(s), one or two muscle(s) $52.59 $36.62 5441 $282.20 P3 $27.97

Injection(s), single to multiple trigger point(s), three or more

20553 $60.58 $41.61 5441 $282.20 P3 $32.62
muscle(s)

6
Musculoskeletal Applications — Procedures that include ultrasound guidance cont.
ASC
Non-facility Facility APC APC
CPT Description payment ASC payment
payment payment code payment
indicator

20612 Aspiration and/or injection of ganglion cyst(s), any location $65.24 $40.94 5441 $282.20 P3 $38.61

Fine needle aspiration biopsy; including ultrasound guidance;

10005 $134.15 $71.90 5071 $670.36 G2 $364.93
first lesion

Fine needle aspiration biopsy, including ultrasound guidance;

Packaged. Packaged. No
10006 each additional lesion (list separately in addition to code for primary $59.92 $49.27 N1
No extra payment. extra payment.
procedure)
Arthrocentesis, aspiration and/or injection; small joint or bursa
20604 (e.g. fingers, toes) with ultrasound guidance, with permanent $82.89 $45.27 5441 $282.20 P3 $49.94
recording and reporting
Arthrocentesis, aspiration and/or injection; intermediate joint or
bursa (e.g. temporomandibular, acromioclavicular, wrist, elbow or
20606 $90.21 $51.60 5442 $658.90 P3 $52.60
ankle, olecranon bursa) with ultrasound guidance, with permanent
recording and reporting
Arthrocentesis, aspiration and/or injection; major joint or bursa
20611 (e.g. shoulder, hip, knee joint, subacromial bursa) with ultrasound $99.53 $58.59 5441 $282.20 P3 $57.92
guidance, with permanent recording and reporting

Obstetrics and Gynecology

ASC
Physician Non-facility APC APC
CPT Description payment ASC payment
payment code payment
indicator
Obstetrical

Ultrasound, pregnant uterus, real-time with image documentation, Global: $117.17

76801 fetal and maternal evaluation, first trimester (<14 weeks 0 days), Professional: $46.27 5522 $104.75 Z2 $57.02
transabdominal approach; single or first gestation Technical: $70.90
Ultrasound, pregnant uterus, real time with image documentation, Global: $59.92
fetal and maternal evaluation, first trimester (< 14 weeks 0 days), Packaged. Packaged. No
76802 Professional: $38.95 N1
transabdominal approach; each additional gestation (list separately No extra payment. extra payment.
in addition to code for primary procedure) Technical: $20.97

Ultrasound, pregnant uterus, real-time with image documentation, Global: $135.48

76805 fetal and maternal evaluation, after first trimester (> or = 14 weeks, Professional: $46.60 5522 $104.75 Z2 $57.02
0 days), transabdominal approach; single or first gestation Technical: $88.88
Ultrasound, pregnant uterus, real time with image documentation, Global: $87.21
fetal and maternal evaluation, after first trimester (> or = 14 weeks Packaged. Packaged. No
76810 Professional: $45.94 N1
0 days), transabdominal approach; each additional gestation No extra payment. extra payment.
(list separately in addition to code for primary procedure) Technical: $41.28

Ultrasound, pregnant uterus, real-time with image documentation, Global: $80.89

Packaged. No
76815 limited (e.g. fetal heartbeat, placental location, fetal position and/or Professional: $30.29 5522 $104.75 N1
extra payment.
qualitative amniotic fluid volume), one or more fetuses Technical: $50.60
Ultrasound, pregnant uterus, real-time with image documentation,
follow-up (e.g. re-evaluation of fetal size by measuring standard Global: $109.85
Packaged. No
76816 growth parameters and amniotic fluid volume, re-evaluation of organ Professional: $39.95 5522 $104.75 N1
extra payment.
system(s) suspected or confirmed to be abnormal on a previous Technical: $69.90
scan), transabdominal approach, per fetus
Global: $118.50
76818 Fetal biophysical profile; with non-stress testing Professional: $49.27 5522 $104.75 Z2 $57.02
Technical: $69.24
Global: $85.55
76819 Fetal biophysical profile; without non-stress testing Professional: $35.95 5522 $104.75 Z3 $58.59
Technical: $49.60

7
Obstetrics and Gynecology cont.
ASC
Physician Non-facility APC APC
CPT Description payment ASC payment
payment code payment
indicator
Non-Obstetrical

Global: $105.19
Ultrasound, pelvic (non-obstetric), real-time with image
76856 Professional: $31.96 5522 $104.75 Z2 $57.02
documentation; complete
Technical: $73.23

Global: $49.27
Ultrasound, pelvic (nonobstetric), real time with image
76857 Professional: $22.97 5522 $104.75 Z3 $31.63
documentation; limited or follow-up (e.g. for follicles)
Technical: $26.30

Procedure Guidance

Global: $57.92
Ultrasonic guidance for needle placement (e.g. biopsy, aspiration, Packaged. Packaged. No
76942 Professional: $29.63 N1
injection, localization device), imaging supervision and interpretation No extra payment. extra payment.
Technical: $28.29

Global: $33.29
Ultrasonic guidance for amniocentesis, imaging supervision and Packaged. Packaged. No
76946 Professional: $17.98 N1
interpretation No extra payment. extra payment.
Technical: $15.31

Pain Management
ASC
Physician Non-facility APC APC
CPT Description payment ASC payment
payment code payment
indicator

Global: $57.92
Ultrasonic guidance for needle placement (e.g. biopsy, aspiration Packaged. Packaged. No
76942 Professional: $29.63 N1
injection, localization device), imaging supervision and interpretation No extra payment. extra payment.
Technical: $28.29

ASC
Non-facility Facility APC APC
CPT Description payment ASC payment
payment payment code payment
indicator

64405 Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve $75.56 $52.59 5441 $282.20 P3 $36.95

Injection(s), anesthetic agent(s) and/or steroid; brachial plexus,

64415 $133.82 $68.57 5443 $868.45 A2 $472.76
including imaging guidance, when performed

Injection(s), anesthetic agent(s) and/or steroid; axillary nerve,

64417 $160.11 $63.25 5443 $868.45 A2 $472.76
including imaging guidance, when performed

64418 Injection(s), anesthetic agent(s) and/or steroid; suprascapular nerve $86.22 $54.92 5442 $658.90 P3 $45.60

Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve,

64420 $97.87 $57.59 5442 $658.90 A2 $358.69
single level

Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve,

64421 each additional level (list separately in addition to code for primary $33.29 $24.63 5443 $868.45 A2 $472.76
procedure)

Injection(s), anesthetic agent(s) and/or steroid; ilioinguinal,

64425 $110.52 $53.93 5442 $658.90 P3 $73.90
iliohypogastric nerves

Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve,

64445 $158.45 $71.24 5442 $658.90 P3 $107.51
including imaging guidance, when performed

Injection(s), anesthetic agent(s) and/or steroid; femoral nerve,

64447 $115.84 $62.25 5442 $658.90 P3 $67.57
including imaging guidance, when performed

8
Pain Management cont.
ASC
Non-facility Facility APC APC
CPT Description payment ASC payment
payment payment code payment
indicator

Injection(s), anesthetic agent(s) and/or steroid; other peripheral

64450 $75.23 $41.61 5442 $658.90 P3 $47.27
nerve or branch

64510 Injection, anesthetic agent; stellate ganglion (cervical sympathetic) $146.47 $76.56 5443 $868.45 A2 $472.76

Pulmonary Medicine
ASC
Physician Non-facility APC APC
CPT Description payment ASC payment
payment code payment
indicator

Global: $56.92
Ultrasound, chest (includes mediastinum), real-time with image Packaged. No
76604 Professional: $26.63 5522 $104.75 N1
documentation extra payment.
Technical: $30.29

ASC
Non-facility Facility APC APC
CPT Description payment ASC payment
payment payment code payment
indicator

Thoracentesis, needle or catheter, aspiration of the pleural space,

32555 $311.24 $106.52 5181 $598.55 G2 $325.84
with image guidance

Pleural drainage, percutaneous, with insertion of indwelling catheter,

32557 $652.43 $145.47 5182 $1,525.93 G2 $619.11
with image guidance

Surgery
ASC
Physician Non-facility APC APC
CPT Description payment ASC payment
payment code payment
indicator

Global: $110.18
Ultrasound, soft tissues of head and neck (e.g. thyroid, parathyroid, Packaged. No
76536 Professional: $26.30 5522 $104.75 N1
parotid), real-time with image documentation extra payment.
Technical: $83.88
Global: $102.53
Ultrasound, breast unilateral, real-time with image documentation Packaged. No
76641 Professional: $34.29 5522 $104.75 N1
including axilla when performed; complete extra payment.
Technical: $68.24
Global: $84.88
Ultrasound, breast unilateral, real-time with image documentation Packaged. No
76642 Professional: $31.96 5521 $86.58 N1
including axilla when performed; limited. extra payment.
Technical: $52.93
Global: $86.88
Ultrasound, abdominal, real-time with image documentation limited
76705 Professional: $27.30 5522 $104.75 Z2 $57.02
(e.g. single organ, quadrant, follow-up)
Technical: $59.59
Global: $57.92
Ultrasonic guidance for needle placement (e.g. biopsy, aspiration, Packaged. Packaged. No
76942 Professional: $29.63 N1
injection, localization device), imaging supervision and interpretation No extra payment. extra payment.
Technical: $28.29
Global: No payment
Packaged. Packaged. No
76998 Ultrasonic guidance, intraoperative Professional: $45.94 N1
No extra payment. extra payment.
Technical: No payment

9
Surgery cont.
ASC
Non-facility Facility APC APC
CPT Description payment ASC payment
payment payment code payment
indicator

Fine needle aspiration biopsy; including ultrasound guidance;

10005 $134.15 $71.90 5071 $670.36 G2 $364.93
first lesion

Fine needle aspiration biopsy, including ultrasound guidance;

Packaged. Packaged. No
10006 each additional lesion (list separately in addition to code for primary $59.92 $49.27 N1
No extra payment. extra payment.
procedure)

19000 Puncture aspiration of cyst of breast $100.20 $41.61 5071 $670.36 P3 $68.57

Biopsy, breast, with placement of breast localization device(s)

19083 when performed and imaging of biopsy specimen, when performed, $492.66 $150.79 5072 $1,544.75 G2 $682.83
percutaneous; first lesion, including ultrasound guidance
Biopsy, breast, with placement of breast localization device(s)
(e.g. clip, metallic pellet), when performed, and imaging of the
Packaged. Packaged. No
19084 biopsy specimen, when performed, percutaneous; each additional $373.82 $75.23 N1
No extra payment. extra payment.
lesion, including ultrasound guidance (list separately in addition to
code for primary procedure)
Placement of breast localization device(s) (e.g. clip, metallic pellet,
Packaged. No
19285 wire/needle, radioactive seeds), percutaneous; first lesion, including $363.17 $82.22 5071 $670.36 N1
extra payment.
ultrasound guidance
Placement of breast localization device(s) (e.g. clip, metallic pellet,
wire/needle, radioactive seeds), percutaneous; each additional Packaged. Packaged. No
19286 $296.59 $41.28 N1
lesion, including ultrasound guidance (list separately in addition to No extra payment. extra payment.
code for primary procedure)

60100 Biopsy, thyroid, percutaneous, core needle $109.52 $75.23 5071 $670.36 P3 $51.93

Vascular Access
ASC
APC APC
CPT Description Physician payment payment ASC payment
code payment
indicator

Ultrasound guidance for vascular access requiring ultrasound

evaluation of potential access sites, documentation of selected Global: $38.28
Packaged. Packaged. No
76937 vessel patency, concurrent realtime ultrasound visualization of Professional: $13.65 N1
No extra payment. extra payment.
vascular needle entry, with permanent recording and reporting Technical: $24.63
(list separately in addition to code for primary procedure)

Vascular Surgery
ASC
Physician Non-facility APC APC
CPT Description payment ASC payment
payment code payment
indicator

Global: No payment
Packaged. Packaged. No
76998 Ultrasonic guidance, intraoperative Professional: $45.94 N1
No extra payment. extra payment.
Technical: No payment
Global: $106.52
Ultrasound, abdominal aorta, real time with image documentation, Not listed on
76706 Professional: $25.63 5522 $104.75
screening study for abdominal aortic aneurysm (AAA) ASC fee schedule.
Technical: $80.89

10
Billing criteria Qualifications of personnel
The use of a pocket-sized ultrasound device may be billable in certain The American Medical Association (AMA) policy states:3
circumstances. Any use has minimum criteria that have to be met
before it can be billed separately from an initial evaluation ultrasound H-230.960 Privileging for Ultrasound Imaging
exam. When the pocket-sized ultrasound device is used for a quick 1. AMA affirms that ultrasound imaging is within the scope of practice
look, and if it is necessary for a follow-up ultrasound to be performed of appropriately trained physicians
on the patient to determine or conclude the patient’s condition, 2. AMA policy on ultrasound acknowledges that broad and diverse use
this would be considered part of the initial exam, or Evaluation and and application of ultrasound imaging technologies exist in medical
Management (E/M) examination being performed. practice
In addition, if the pocket-sized ultrasound device is used as an 3. AMA policy on ultrasound imaging affirms that privileging of the
extension of the patient’s physical examination, it would not be physician to perform ultrasound imaging procedures in a hospital
appropriate to bill separately for these ultrasound exams. Rather, setting should be a function of hospital medical staffs and should be
these ultrasound exams would be included as an extension of an specifically delineated on the Department’s Delineation of Privileges
E/M examination. Refer to your coding manual to select appropriate form
CPT codes that address E/M examinations. 4. AMA policy on ultrasound imaging states that each hospital medical
staff should review and approve criteria for granting ultrasound
Diagnostic Use of Pocket-Sized Ultrasound Device
privileges based upon background and training for the use of
If use of the pocket-sized ultrasound device is medically necessary, ultrasound technology and strongly recommends that these criteria
it should be well documented in the patient’s medical record, be are in accordance with recommended training and education
performed by a qualified provider, and meet all Medicare requirements, standards developed by each physician’s respective specialty.
including documentation and storage of images. In such cases, it may (Res. 802, I-99; Reaffirmed: Sub. Res. 108, A-00 / Reaffirmed: CMS
be possible for it to be billed and considered for coverage and payment Rep. 6, A-10)
by a payer.

Documentation requirements
Billing requirements for pocket-sized
Ultrasound performed using a pocket-sized device, a handheld
ultrasound device ultrasound, a compact portable, or a console ultrasound system may
According to many local Medicare contractors, billing for a limited be reported using the same CPT codes as long as the studies performed
diagnostic ultrasound procedure requires that the following minimum meet the requirements addressed above, as well as all the following
requirements be met: requirements:

• It should be done for the same purpose as a reasonable physician • Medical necessity as determined by the payer
would order a standard ultrasound. • Completeness
• It must be billed using the CPT code that accurately describes • Documented in the patient’s medical record
the service performed. A separate written record of the ultrasound procedure(s) should be
• The technical quality of the exam must be in keeping with the maintained in the patient record.4 This should include a description
accepted national standards and not require a follow-up ultrasound of the structures or organs examined, the findings, and reason for
to confirm the results. the ultrasound procedure(s). Images are to be labeled with patient
• The study must be performed and interpreted by qualified individuals. identification, facility identification, examination date, the anatomical
• The medical necessity, images, findings, interpretation, and report site imaged, transducer orientation, and the initials of the operator.
must be documented in the medical record. The use of ultrasound without a thorough evaluation of organ(s) or
anatomical region, image documentation, and final written report is
• It must be medically reasonable and necessary for the diagnosis
not separately reportable.
or treatment of illness or injury.
In order to be separately reportable, diagnostic ultrasound procedures
require the production and retention of image documentation. It is
recommended that permanent ultrasound images, either electronic or
hard copy, from all ultrasound services be retained in the patient record
or other appropriate archive.

Payers or their local branches and the local Medicare contractors may have distinct requirements and policies. Before filing any claims, providers should verify current
requirements and policies with the local payer and/or Medicare contractor. 11
Coverage policies ICD-10-CM diagnosis coding
Use of diagnostic ultrasound services may be a covered benefit if such It is the physician’s ultimate responsibility to select the codes that
usage meets all requirements established by that particular payer. appropriately represent the service performed, and to report the
It is advisable that you check with your local Medicare contractor for ICD-10-CM code based on his or her findings or the pre-service signs,
specific coverage requirements. Also, it is essential that each claim be symptoms, or conditions that reflect the reason for performing
coded appropriately and supported with adequate documentation in the ultrasound.
the medical record. Coverage by private payers varies by payer and by
plan with respect to which medical specialties may perform ultrasound
services. Some payers will reimburse ultrasound procedures to all
Limited vs. complete ultrasound
specialties while other plans will limit ultrasound procedures to specific Complete and limited ultrasound studies are defined in the ultrasound
types of medical specialties. In addition, there are plans that require introductory section notes of the CPT 2023 procedural code book.
providers to submit applications requesting these services be added According to CPT, the report should contain a description of all
to the list of services performed in their practice. It is important that elements or the reason that an element could not be visualized.
you contact the payer prior to submitting claims, to determine their As stated in the guidelines:
requirements.
“If less than the required elements for a ‘complete’ exam are reported
(e.g. limited number of organs or limited portion of region evaluated),
Modifiers the limited code for that anatomic region should be used once per
patient exam session.” 5
Modifiers explain that a procedure or service was changed without
changing the definition of the CPT code set. Here are some common
modifiers related to the use of ultrasound procedures. Other considerations
26: Professional Component The American Society of Echocardiography (ASE) published a position
statement (J Am Soc Echocardiog 2002; 15: 369-73) about hand-carried
A physician who performs the interpretation of an ultrasound exam
ultrasound in April 2002. This position establishes that:
in the hospital outpatient setting may submit a charge for the
professional component of the ultrasound service using a modifier “The safety and effectiveness of a diagnostic study should be judged on
(–26) appended to the ultrasound code. the medical indications of the study, the qualifications and experience
of the providers of service, the quality and completeness of the
TC: Technical Component diagnostic information obtained, and the adherence to published and
This modifier would be used to bill for services by the owner of the widely accepted professional standards and processes developed, and
equipment only to report the technical component of the service. not based on the size or cost of the instrumentation used to perform
This modifier is most commonly used if the service is performed the study.” 6
in an Independent Diagnostic Testing Facility (IDTF). Furthermore, the ASE document states the technical capabilities of
Hand Carried Ultrasound (HCU) equipment do not themselves serve as
52: Reduced Services
a means for distinguishing a complete or limited echocardiogram from
This modifier would be used in certain circumstances when a service an extension of a physical exam. Therefore, if the appropriate images
or procedure is partially reduced or eliminated at the physician’s and data are recorded as follows, the study should be considered an
discretion. independent diagnostic test, rather than an extension of the patient’s
physical examination.
76: Repeat Procedure by Same Physician
Therefore, if the appropriate images and data are recorded as follows,
This modifier is defined as a repeat procedure by the physician on
the study should be considered an independent diagnostic test, rather
the same date of service or patient session. The CPT defines “same
than an extension of the patient’s physical examination:
physician” as not only the physician doing the procedure, but also
as a physician of the same specialty working for the same medical • A qualified sonographer or physician interprets the ultrasound exam
group/employer. • Interpreted by a physician with a level 2 (or higher) training in
echocardiography (level 2 is described by the American College
77: Repeat Procedure by Another Physician
of Cardiology (ACC) here: www.acc.org/~/media/non-clinical/
This modifier is defined as a repeat procedure by another physician on files-pdfs-excel-ms-word-etc/ guidelines/2015/031315_cocats4_
the same date of service or patient session. “Another physician” refers unified_document.pdf
to a physician in a different specialty or one who works for a different • Reported in an appropriate manner
group/employer. Medical necessity for repeating the procedure must
• Archived properly
be documented in the medical record in addition to the use of
• The study was performed for an approved clinical indication
the modifier.

12
 Disclaimer
The information provided with this notice is general
reimbursement information only; it is not legal advice, nor is
it advice about how to code, complete or submit any particular
claim for payment. It is always the provider’s responsibility to
determine and submit appropriate codes, charges, modifiers
and bills for the services that were rendered. This information
is provided as of January 1st, 2024. All coding and
reimbursement information is subject to change without
notice. Payers or their local branches may have distinct coding
and reimbursement requirements and policies. Before filing
any claims, providers should verify current requirements and
policies with the
local payer.
Third party reimbursement amounts and coverage policies for
specific procedures will vary including by payer, time period
and locality, as well as by type of provider entity.
This document is not intended to interfere with a health care
professional’s independent clinical decision making. Other
important considerations should be taken into account when
making decisions, including clinical value. The health care
provider has the responsibility, when billing to government
and other payers (including patients), to submit claims or
invoices for payment only for procedures which are
appropriate and medically necessary. You should consult with
your reimbursement manager or healthcare consultant, as well
as experienced legal counsel.

1. Information presented in this document is current as of January 1st, 2024. Any subsequent changes which may occur in coding, coverage and payment are not reflected herein.

2. The federal statute known as the Stark Law (42 U.S.C. §1395nn) imposes certain requirements, which must be met in order for physicians to bill Medicare patients for in-office
radiology services. In some states, similar laws cover billing for all patients. In addition, licensure, certificate of need, and other restrictions may be applicable.

3. https://policysearch.ama-assn.org/policyfinder/detail/Ultrasound%20imaging?uri=%2FAMADoc%2FHOD.xml-0-1591.xml

4. Certain Medicare carriers require that the physician who performs and/or interprets some types of ultrasound examinations prove that they have undergone training through recent
residency training or postgraduate CME and experience. For further details, contact your Medicare contractor.

5. 2023 Current Procedural Terminology (CPT®) Professional Edition. CPT is a registered trademark of the American Medical Association. All rights reserved. No fee schedules, basic
units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

6. American Society of Echocardiology Report on Hand Carried Ultrasound (HCU) - April 2002 (J AM Soc Echocardiog 2002; 15:369-73).

7. Third party reimbursement amounts and coverage policies for specific procedures will vary by payer and by locality. The technical and professional components are paid under the
Medicare physician fee schedule (MPFS). The MPFS payment is based on relative value units published in Federal Register/Vol 88/November 18th, 2022. These changes are effective
for services provided from 1/1/2023 through 12/31/2023. CMS may make adjustments to any or all of the data inputs from time to time. Amounts do not necessarily reflect any
subsequent changes in payment since publication. To confirm reimbursement rates for specific codes, consult with your local Medicare contractor.

8. Third party reimbursement amounts and coverage policies for specific procedures will vary by payer and by locality. The technical component is a payment amount assigned to an
Ambulatory Payment Classification under the hospital outpatient prospective payment system, as published in the Federal Register/Vol 88/November 18th, 2022. These changes are
effective for services provided from 1/1/2023 through 12/31/2023. CMS may make adjustments to any or all of the data inputs from time to time. Amounts do not necessarily reflect
any subsequent changes in payment since publication. To confirm reimbursement rates for specific codes, consult with your local Medicare contractor.

* Physician ‘Facility’ = Procedure done in a facility other than the physician’s office.
‘Physician Non-facility’ = Physician’s office.

** Professional is the physician payment (–26). Technical is the facility payment (TC).

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October 2024
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