January 2004 | Vol. 22/No. 1

Medicare Reaffirms Coverage for Services Provided With Hand Carried Ultrasound Systems

("Reprinted with permission from the American Institute of Ultrasound in Medicine (AIUM) Sound Waves newsletter, November/December 2003.")

Medicare has recently clarified that ultrasound services are reimbursable of whether the system used is a hand carried ultrasound (HCU) system or larger cart-based system.

Earlier this year, 6 local Medicare carriers issued policies restricting payment for ultrasound services performed with HCU systems - an action that affected 22 states. In response to these policies, several national medical societies, including the American Society of Echocardiography, the Society of Radiologists in Ultrasound, the Society for Vascular Ultrasound, the Society of Diagnostic Medical Sonography, and the American Society of Neuroimaging, and accrediting bodies (Intersocietal Commission for the Accreditation of Echocardiography Laboratories and Intersocietal Commission for the Accreditation of Vascular Laboratories), as well as several coding specialists, informed Medicare that HCU products could provide comprehensive diagnostic services and requested that the HCU policies be reconsidered. Members of Congress also expressed concerns that these policies were inappropriate.

The organizations listed above notified the various Medicare carriers that HCU systems are capable of providing diagnostic services described by existing ultrasound current procedural terminology (CPT) codes. Initial versions of HCU products provided only two-dimensional (2D) and color imaging; some did have video-out connections that permitted printing of hard copies of the images obtained. However, the latest HCU systems on the market offer all of the conventional imaging modes required to perform complete diagnostic services including 2D, color, pulsed wave and continuous wave Doppler and M-Mode. Additionally, these HCU systems include measurements and comprehensive calculation packages, and offer complete documentation capabilities, including the DICOM (digital imaging and communication in medicine) standard.

Each of the local Medicare carriers reviewed the information presented to them by the numerous ultrasound-related organizations and Congress, and restated their policies. The new policies state that the appropriate use of a CPT code and subsequent payment is not properly based on the size of the ultrasound system used, but by the service provided. Ultrasound services, regardless of the size of the system used, must be performed out of medical necessity, include proper documentation, be interpreted and performed by qualified individuals, and use the proper ICD-9 and CPT codes.

In addition, the American Medical Association passed resolution 126 in June 2003, which "vigorously opposed actions by medical insurers to deny payment for services simply on the basis of the size of medical equipment." The resolution was introduced by the American College of Emergency Physicians, the American College of Obstetricians and Gynecologists, and the American College of Surgeons and was supported by the American Institute of Ultrasound in Medicine and the American College of Radiology, among others.

According to a leading ultrasound market analyst, "A significant majority of those who purchase HCU systems are in the traditional imaging specialties, including radiology, cardiology, vascular, obstetrics, and gynecology. HCU is one of, if not the, fastest growing product segments. In 2002, approximately 14% of ultrasound units delivered in the United States were HCU systems."

Medicare has recognized that miniaturization is an ongoing trend for ultrasound systems. This progression toward smaller and more fully featured systems is accompanied by improved performance. Several HCU manufacturers predict that within the next year or two, HCU systems will offer features and image quality found on today's high-end full-size systems. The use of HCU systems can enhance the delivery of imaging services while ensuring the maintenance of high-quality standards.