Medicare doubles payment for certain contrast-enhanced ultrasound scans
Medicare is doubling reimbursement for certain contrast-enhanced ultrasound scans, drawing praise from the imaging industry.
The federal payment program for seniors revealed the update in its hospital outpatient final rule, published in the Federal Register Tuesday. Beginning Jan. 1, Medicare will increase payment for noncardiac, contrast-enhanced ultrasound from $170.02 to $358.35.
It’s also reassigning noncardiac CEUS imaging to the same billing code used for both contrast-enhanced CT and MRI (APC 5572, Level 2 Imaging with Contrast). The Centers for Medicare & Medicaid Services said this change “recognizes the specialized nature of contrast-enhanced ultrasound” while ensuring it receives “appropriate payment for these services.”
Industry advocates praised the decision. Earlier this year, the International Contrast Ultrasound Society had warned low reimbursement is keeping physicians from using the modality.
“Studies show that a simple, low-cost CEUS scan can offer sensitivity and specificity equivalent to that of CT and MRI,” Richard G. Barr, MD, a professor of radiology at Northeast Ohio Medical University and officer of the society, said in a Nov. 25 announcement. “They do not contain iodine or gadolinium and have not been shown have an effect on thyroid or renal function,” he added.
Contrast-enhanced ultrasound uses intravenously infused microbubble agents to enhance images, the society noted. This allows or visualization of abnormal microvascular blood flow patterns without exposing patients or providers to radiation. CEUS is utilized worldwide to characterize cancers, diagnose heart disease and monitor therapy. But its deployment in the U.S. has lagged due to low reimbursement, the society contends.
ICUS touted other benefits of the modality on Tuesday. Contrast CT or MR often are not options for patients with impaired kidneys due to nephrotoxicity or allergic reactions. Plus, contrast ultrasound can reduce healthcare costs by cutting the need for downstream tests and unnecessary interventional procedures. These scans also can be administered at the bedside, avoiding the need for transport to CT or MR.
“CEUS costs far less than contrast MR or CT, and it often does a better job,” Barr said in the announcement.
The society noted that three ultrasound contrast agents are commercially available in the U.S. These include Lumason from Bracco Imaging, Definity from Lantheus and Optison from GE HealthCare (all three companies are members of the society). However, only Lumason is currently approved by the U.S. Food and Drug Administration for noncardiac indications.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.