Under-reimbursement keeping radiologists from using key imaging modality, docs warn CMS
Under-reimbursement is keeping physicians from using a key imaging modality, docs warned the Centers for Medicare & Medicaid Services on Tuesday.
Their concern relates to low utilization of contrast-enhanced ultrasound in clinical scenarios other than cardiology. Such exams serve as a safe, cost-effective and radiation-free alternative to other imaging options. Yet, radiologists and other physicians are looking elsewhere due to inadequate payment.
To remedy this, the International Contrast Ultrasound Society is asking CMS to reassign two CPT codes—76978 and 76979, both covering noncardiac scans—from Level 1 to Level 2. This would bring CEUS into line with similarly contrast-enhanced MRI and CT exams, providing a “clinical coherency that does not exist” under current payment policy.
“Unfortunately, despite the very successful and widespread use of [contrast-enhanced ultrasound], … under-reimbursement in the United States may impede the appropriate use of CEUS … potentially to the detriment of patients,” Andrej Lyshchik, MD, PhD, with Thomas Jefferson University in Philadelphia, said in a statement from the society.
The radiologist, who also chairs the American College of Radiology’s LI-RADS CEUS Working Group, and colleagues recently wrote a letter to CMS about this issue. They’re urging agency Administrator Mehmet Oz, MD, and HHS to push for policy modifications related to sonography. The request to bump CEUS to Level 2 would increase reimbursement from $179.73 to $358.35, based on estimates provided by the society and derived from the proposed 2026 fee schedule.
This could help to spur greater use of the modality, which is already widely deployed in abdominal imaging across other countries. The International Contrast Ultrasound Society—sponsored by imaging agent manufacturers such as Bracco, GE HealthCare, Lantheus, Siemens Healthineers and Canon—hopes a Medicare policy change would spur reform across commercial plans, too.
They note that CEUS eliminates the need to transport patients to CT and MRI suites, avoiding delays and allowing for real-time diagnoses. Commercially available contrast agents are safe, they contend, and recommended by medical societies.
“Medicare coverage policy should use payment to favor use of cost-effective imaging and to take advantage of existing clinical guidelines,” members of the ICUS Board of Directors wrote to Dr. Oz. “Such an approach would give providers a financial incentive that is aligned with best-practice medicine.”
ICUS bills itself as a nonprofit medical society focused on the “safe and appropriate utilization” of CEUS. Alongside radiologists, its members include oncologists, hepatologists, cardiologists, nurses, sonographers and other professionals.
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.