Echography & Sonography

Affected Providers

Physicians and non-physician practitioners who write prescriptions or orders for echography and sonography services.

Background

According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rates for echography and sonography services are:

• Carotid Arteries: 21.7% improper payment rate, with a projected improper payment amount of $42.4 million
• Heart: 7.6% improper payment rate, with a projected improper payment amount of $55.4 million
• Other: 4.5% improper payment rate, with a projected improper payment amount of $32.8 million

You must meet the provisions in National Coverage Determination (NCD): Ultrasound Diagnostic Procedures (220.5). We outline other policy requirements in: 

• Local Coverage Determination (LCD): Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography (L33950)
• LCD: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography (L33585)

Ultrasound diagnostic procedures using low energy sound waves are used to find the composition and contours of nearly all body tissues except bone and air-filled spaces. This technique allows non-invasive visualization of even the deepest structures in the body.

Denial Reasons

Insufficient documentation accounted for 71.6% of improper payments for echography and sonography services (for carotid arteries) during the 2024 reporting period, while no documentation (22.5%) and other errors (6.0%) also caused improper payments. “Other” errors include duplicate payment, non-covered or unallowable service, or ineligible Medicare patient errors.

Preventing Denials

You must meet specific requirements when ordering diagnostic lab tests. See Medicare Benefit Policy Manual, Chapter 15, section 80.6.