Dr. Gittleman's Coding Corner: Do I need to be certified/accredited to bill for breast ultrasound?

Question: I am a surgeon, do I need to be certified and/or accredited to bill for and receive payment for performing breast ultrasound?

Answer: It depends....Although Medicare has no requirement for either certification of the provider or facility accreditation in breast ultrasound for a surgeon to submit billing and receive payment for breast ultrasound, many private insurance companies do require surgeons to be certified in breast ultrasound, or for the facility in which the procedure is being performed to be accredited in breast ultrasound. Certification applies to the individual provider, whereas accreditation refers to the facility (private office, imaging center, hospital out-patient department, etc.

Surgeons may obtain certification in breast ultrasound through the American Society of Breast Surgeons. A surgeon's practice can also receive breast ultrasound practice accreditation through either the American Society of Breast Surgeons or the American Institute for Ultrasound in Medicine.

Again, for Medicare, there are no requirements, but private payers' policies vary.