POCUS Billing Readiness Checklist: 6 Essentials to Get Paid
Point-of-care ultrasound (POCUS) is transforming how frontline providers diagnose and manage patients. It offers faster answers, improved outcomes, and new streams of revenue. But many clinics miss out on reimbursement due to avoidable gaps in billing infrastructure.
That’s why we created the POCUS Billing Readiness Checklist—a simple guide to help you assess whether your clinic is truly ready to get paid for the scans you're already performing (or planning to start).
Here’s a breakdown of each essential element:
1. Include POCUS CPT Codes in Your Private Payer Contracts
Before billing, make sure the ultrasound CPT codes you plan to use (such as 76882 or 76604) are actually included in your payer contracts. This is often overlooked and can result in denials, even with proper documentation. If they’re not listed, you may need to renegotiate or submit a contract amendment.
2. Ensure Providers Are Credentialed in POCUS
Many payers require that the provider performing the scan is trained and credentialed. Clinical competence alone isn't always enough. Documentation of credentialing is often reviewed during audits. We help clinics set up a structured credentialing pathway aligned with ACEP, AIUM, or similar standards to meet this requirement.
3. Store Images Securely and Indefinitely
Image storage is a frequent point of failure. Payers often request access to original ultrasound images, especially during an audit. Using a HIPAA-compliant archiving solution that links images to the patient's record and retains them indefinitely is critical to both compliance and long-term revenue protection.
4. Use a Dedicated Procedure Note
Ultrasound findings should be documented in a separate procedure note, not just buried in a general progress note. This note should clearly state the scan type, indication, who performed it, key findings, and the interpretation. Standardized templates can make this a quick and repeatable part of your documentation workflow.
5. Clearly Document Medical Necessity
To justify reimbursement, your documentation must explain why the scan was necessary. That means connecting the ultrasound to the patient's symptoms or clinical concern. Avoid vague or templated language. Be specific and focused on how the scan informed your decision-making.
6. Use the Correct CPT Code and Modifier
Reimbursement often hinges on correct coding. Use the proper CPT code (for example, limited vs. complete) and apply the correct modifier when needed, such as -26 for professional interpretation or -TC for technical components. Understanding your payer’s specific expectations can significantly reduce denials.
Special Considerations for FQHCs
Federally Qualified Health Centers (FQHCs) operate under a unique payment structure. They are often reimbursed through Prospective Payment System (PPS) rates or an Alternative Payment Methodology (APM), meaning standard CPT-based billing may not apply to all POCUS services in the same way it does for private clinics or urgent care centers. However, accurate documentation of POCUS services remains essential for compliance, reporting, and demonstrating cost-effectiveness—especially in value-based care arrangements. Credentialing, image storage, and medical necessity documentation are just as important, particularly for audits and grant reporting. Additionally, some states and payers allow for PPS carve-outs or separate reimbursement for diagnostic procedures like ultrasound, especially when performed by credentialed providers. FQHCs should closely review state Medicaid policies and payer contracts to determine how best to integrate and bill for POCUS within their payment model.
Authored by Dr. Tatiana Havryliuk. Reviewed by Brad Laymon from Coding Excellence.
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