Mobile ultrasound services are reported using the same ultrasound codes used for cart-based ultrasound studies assuming all applicable requirements for that code are met. All ultrasound studies must meet the requirements of:
Medical necessity as determined by the payer
Completeness and accuracy for the code selected
Documented in the patient record
Laws and regulations regarding reimbursement change frequently and providers are solely responsible for all coding and billing decisions including determining, if and under what circumstances, it is appropriate to seek reimbursement for products and services and obtaining pre-authorization, if necessary. We recommend that providers verify current requirements with the payer before filing any claims.
Procedures are reported
using Current Procedural Terminology (CPT) codes or Common Procedural Coding
Systems (HCPCS) Codes. Payments are assigned to procedure codes.
The amount allowed by payers for the interpretation of an ultrasound study is the same no matters where it occurs. However, for some payers, like Medicare the amount paid for the image acquisition differs depending on whether the study is performed in a hospital or non-hospital.
Payments for ultrasound procedures performed in non-hospital settings are composed of a professional component and a technical component. The professional component represents physician work only and the technical component represents facility overhead, including equipment costs, and staff time. When the physician component is reported separately, the service is identified by adding modifier -26 to the CPT/HCPCS procedure code. When the technical service is reported separately, the service may be identified by adding a -TC modifier to the CPT/HCPCS procedure code.
In the case of procedures performed in a hospital, the physician only bills for the professional component (-PC), and the hospital bills for the facility overhead, equipment and staff time as a facility services.