CHICAGO -- Contrast-enhanced ultrasound (CEUS) may be in for a boom in usage in 2026 and beyond, thanks to recent legislation and interest.
Richard Barr, MD, PhD, from Northeast Ohio Medical University in Rootstown, spoke with AuntMinnie at RSNA 2025 about recent developments in CEUS, including updated reimbursement from the Centers for Medicare & Medicaid Services (CMS) and research that shows the modality’s efficacy and safety.
“There’s a lot of new technology coming to interpret images better,” said Barr, who serves as chair for the Quantitative Imaging Biomarkers Alliance (QIBA) ultrasound contrast committee of the RSNA. He is also an officer at the International Contrast Ultrasound Society (ICUS) and editor in chief of the Journal of Ultrasound in Medicine.
Increased reimbursement for CEUS
The CMS in November announced that payment for certain CEUS exams will increase under a newly assigned billing code. Effective January 1, 2026, this change will double noncardiac CEUS reimbursement from $170.02 to $358.35.
It also reassigns noncardiac CEUS to the same billing code used for contrast-enhanced CT and MRI exams. Specifically, the billing code is APC 5572 (level 2 imaging with contrast).
Barr said this change will provide a financial incentive for CEUS’ clinical use.
Richard Barr, MD, PhD, talks about the benefit of a CMS measure that will double reimbursement for noncardiac CEUS exams.
CEUS’ benefits
At RSNA, Barr moderated a hands-on CEUS course for about 50 participants, including live cases from Canada, Germany, and India. He also moderated a scientific session where studies showcased advancements in ultrasound imaging.
Barr said CEUS has its share of advantages over contrast-enhanced CT and MRI. Prior research suggests that ultrasound contrast agents are safer than iodinated or gadolinium chelate contrast agents since they have no effect on kidney and thyroid function. This does not expose patients to radiation and could serve well for patients with contraindications toward either CT or MRI.
“We can now use these agents for patients with renal failure and even pregnant patients because the bubbles will not cross into the placenta and not get to the fetus,” Barr said.
He added that patients with a cancer diagnosis should undergo a contrast study to evaluate metastases.
Recent research also suggests that adverse events from ultrasound contrast agents are low in incidence, and that discomfort experienced by patients is mostly transient and doesn’t last more than a few minutes if that long.
Still, Barr said that practices that wish to use CEUS should have safeguards in place in case patients experience severe events like anaphylactic shock.
Barr discusses benefits and considerations for using CEUS in clinical settings.
Next steps
Barr said ICUS plans to send a petition to the U.S. Food and Drug Administration (FDA) to remove its black box warning over the use of ultrasound contrast agents.
“They have removed the vast majority of contraindications that were in that box, but there are a few that are in there that are inappropriate,” he said.
Barr also said ICUS plans to send a petition to the FDA for a whole-body approval for CEUS. This could allow for vendors to educate CEUS users on better using their equipment, administering drugs, and providing diagnostic imaging.
For full coverage of RSNA 2025, visit our RADCast.
![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&fit=crop&h=100&q=70&w=100)
![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)
