The International Contrast Ultrasound Society (ICUS) has asked the Centers for Medicare and Medicaid Services (CMS) to update reimbursement for certain contrast-enhanced ultrasound (CEUS) imaging procedures.
In a letter submitted by its board of directors, the ICUS requested that the CMS reassign CPT Codes 76978 and 76979, which cover noncardiac CEUS scans, to APC 5572 (Level 2 Imaging with Contrast). The ICUS said that it is not seeking a change in reimbursement for cardiac CEUS.
The ICUS stated that contrast-enhanced CT and MRI procedures are already assigned to APC 5572; therefore, reassignment of CEUS would establish “clinical coherency that does not exist under the current APC assignment for CPT 76978.”
The ICUS said that its request for updated coding for non-cardiac CEUS is being made to align reimbursement with the clinical and economic benefits of the procedure.
CEUS is used worldwide to assess blood flow in real-time, allowing physicians to characterize tumors, stratify a patient’s risk of heart attack and stroke, monitor chronic gastrointestinal diseases and other conditions, and evaluate whether cancer therapies and other treatments are working, according to the ICUS.
CEUS uses commercially available ultrasound contrast agents (UCAs) that are administered intravenously, do not contain iodine or gadolinium, and are not nephrotoxic. The procedure is considered suitable for patients with renal failure for whom contrast-enhanced CT or MRI cannot be used. CEUS may also be appropriate for pregnant patients, as UCAs do not cross the placental barrier and because the procedure does not entail exposure to ionizing radiation or iodinated contrast.
Furthermore, ultrasound systems are more readily available in many medical centers than MRI or CT, making CEUS more accessible to patients, the ICUS noted.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
