Society of Diagnostic Medical Sonography

Coding and Reimbursement Resources

Reimbursement policies for medical procedures such as diagnostic medical sonography are complex and may vary from state to state and, sometimes, may vary within a state. Below are various coding and reimbursement resources to assist you in navigating reimbursement policies.

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HHS logoMedicare Reimbursement

The Centers for Medicare and Medicaid Services (CMS) provides ​the Medicare Coverage Database (MCD), which contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD decisions. To determine what Medicare coverage determinations are in place, you should use the Quick Search or Advanced Search tool to find current policies in your geographic area/region.​ A LCD is a decision by a fiscal intermediary (FI) or carrier whether to cover a particular service on an intermediary-wide or carrier-wide basis (e.g., a determination as to whether the service or item is reasonable and necessary). FIs, Carriers, and Medicare Administrative Contractors (MACs) are Medicare contractors that develop and/or adopt LCDs. Medicare contractors develop LCDs when there is no National Coverage Determination (NCD) or when there is a need to further define an NCD. 

Medicare Coverage Database

Search both the NCD and LCD databases using a variety of criteria such as keyword, diagnosis/procedure, and date.

Quick Search   Advanced Search

Other Medicare Tools

  • Medicare Contractor Directory (​interactive map to determine Medicare carrier for a geographic area/region)
  • Medicare Physician Fee Schedule (searchable database that provides payment information for services covered by the MPFS provided by physician and non-physician practitioners)
  • ICD-10 Lookup Tool (the International Classification of Diseases, Tenth Edition is a clinical cataloging system being implemented in the U.S. healthcare industry.)
  • MedPAC​ paymentBasics are simple guides from the Medicare Payment Advisory Commission about the Medicare payment system.
  • National Provider Identifier Registry Public Search is a free directory of all active National Provider Identifier (NPI) records. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry.

Other Reimbursement Policy Resources

The Intersocietal Accreditation Commission (IAC) maintains a listing of CMS and Third-Party Insurer Payment Policies related to vascular and cardiac (echocardiography) sonography: Some insurers work with radiology "benefits management companies” to coordinate benefits. These companies may set requirements for preauthorization or other quality standards. ​While ​EviCore does not verify the diagnostic imaging personnel’s certifications for every examination performed, that ​EviCore expects the facility to ensure that the personnel are currently certified:

Note: CareCore National merged with MedSolutions and is now known as EviCore

The following appeared in a recent New Jersey court case involving a sonography student and could provide some insight ​on how insurer requirements might be viewed by a court of law: 

CareCore National, a benefit management company hired by most of the major insurance companies (Aetna, BCBS, Healthnet, United [H]ealth, Oxford and GHI) to either pay for imaging services, pre-authorize examinations or both, [has] unequivocally stated that, “CareCore standards state that all non-certified U/S technologist and non-board certified radiologist, may no longer render services to patients whose health plans are clients of Care Core National.”

Source: Suarez v. E. Int'l Coll., 428 N.J.Super. 10, 50 A.3d 75 (N.J. Super., 2012)