Empire Medicare Services has received claims and inquiries about the use of color flow Doppler ultrasound when imaging suspect malignant tumors. After review of CPT, we have concluded that color flow Doppler is only reimbursable as a separate test when performed for evaluation of vascular structures, and not when used only for anatomic structure identification.

We interpret vascular structures to mean large arteries and veins, where the purpose of the study is to evaluate the flow in these vessels and areas of vascular anatomic abnormalities that may have medical consequence (e.g., stenoses, obstructions, and dilatation or aneurysms). These services are generally billed using CPT codes in the 93875-93990 range. Doppler echocardiography color flow velocity mapping (93325) is separately reimbursable when performed as an add-on to standard echocardiography services.

Anatomic structure identification is interpreted to mean the use of the Doppler color flow to identify differential areas of flow, that help to identify the structure on ultrasound, as for the purpose of diagnosing malignancy. In these instances, the test is not identifying discrete abnormalities of individual vessels, but rather identifying regions with abnormal flow to them. For these purposes, the color flow Doppler is considered part of the ultrasound examination of the organ or region, and is not separately reimbursable.

Posted: 11/29/2005

CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.