J Emerg Med. 2025 Oct 22;80:145-151. doi: 10.1016/j.jemermed.2025.10.015. Online ahead of print.

BACKGROUND: The 2023 Centers for Medicare and Medicaid Services (CMS) billing guidelines allowed a refocus on medical decision-making, the risk of morbidity, and overall medical complexity. It is uncertain how point-of-care ultrasound (POCUS) billing has been affected by these changes. Elucidation of how 2023 CMS changes to POCUS billing can allow us to ensure alignment with best practices.

OBJECTIVE: To investigate the effect of the 2023 CMS changes on POCUS billing.

METHODS: This was a retrospective cohort study performed at a large urban quaternary care center. The baseline characteristics of patients and volume of documented POCUS, as well as by Current Procedural Terminology (CPT) codes and reimbursement rates in 2022 and 2023, were compared. We also evaluated the proportion of charts in which POCUS was incorporated into medical decision-making in 2 months in 2023.

RESULTS: In total, there were 2900 and 2778 patient encounters with at least one POCUS documentation in 2022 and 2023, respectively. There was no difference in the volume of POCUS billed monthly, or CPT codes of billed POCUS between 2022 and 2023 (p = 0.47 and 0.90, respectively). Reimbursement rates for separately billed POCUS procedures remained unchanged, with an exception to private insurance, where reimbursement rate increased slightly (p = 0.011). There was a small proportion of visits (4.1%) in which POCUS billing affected the evaluation and management code for the emergency department visit.

CONCLUSIONS: The 2023 CMS changes to billing have not significantly changed billing practices for POCUS.

PubMed:41275847 | DOI:10.1016/j.jemermed.2025.10.015