Point-of-care ultrasound (POCUS) is transforming the way healthcare providers approach diagnostics, enabling immediate insights that enhance patient care. As this tool becomes more integrated into clinical practice, we, as healthcare professionals, face some challenges when building a sustainable POCUS program. From selecting the right equipment to navigating certification, credentialing, and billing, there’s a lot to consider.
The first and most crucial question when building a POCUS program is which probe to buy. With a wide variety of handheld ultrasound devices on the market, it can be overwhelming to make a choice. Here’s what to consider:
Cost and Subscription Fees: This is often the first factor. Handheld devices can range in price from around $3,500 to $8,000, depending on the model and features. Keep in mind that some devices come with additional subscription fees for cloud storage, image enhancement, or advanced features.
Corded vs. Cordless: Handheld probes come in both corded and cordless models. Cordless probes offer flexibility and portability, but may require more frequent charging and careful management of battery life. Corded probes, on the other hand, provide consistent performance without the worry of battery limitations but are less portable and could age out if connection ports change (for example, lightning port to USB-C).
Image Quality: Image clarity is a top priority when selecting a probe. Recent studies, including those by Perez-Sanches et al. and Le et al., show that the GE Vscan Air and Philips Lumify rank highest for image quality in head-to-head comparisons of handheld ultrasound devices. The Vscan Air was also rated as the probe most likely to be carried in a physician’s coat pocket due to its size, wireless capability, and solid image performance.
Cloud and IT Integration: Many devices now integrate with cloud services or electronic health records (EHR) for easy storage and sharing. This feature can save you time and streamline your documentation processes.
Some of the top contenders in the handheld ultrasound market that have been compared in head-to-head trials include (all prices are approximations and can vary based on timing and market):
GE Vscan Air: Wireless, with cloud capability, and offers both curvilinear + linear dual probe and phased array + linear dual probe imaging options. Starting at ~$4,500.
Philips Lumify: Corded and designed to work with a tablet. Offers multiple individual probes but lacks cloud storage at this time, so images are stored locally on the tablet or sent to DICOM destination. Priced around $6,000.
Kosmos by Echonous: Corded, with a strong focus on AI and educational features. Offers multiple individual probes. Priced around $5,000 per probe.
Butterfly iQ: Corded, with improvements in image quality but limited in cardiac imaging. “All in one” single probes. Priced around $3,900 for the probe with an additional annual cloud subscription fee of approximately $300 to $420.
Clarius: Wireless, with some connectivity issues reported. Individual probe options available. Prices range from $3,500 to $5,400 per probe with an additional $595 annual fee.
Mindray TE Air: Wireless and only compatible with iOS devices. Currently only has phased array option. Priced between $6,000 and $8,000.
One of the biggest questions healthcare professionals face is how to get certified or credentialed to perform POCUS. While there's no national certification for POCUS (unlike many other medical procedures), there are several certificate of completion programs offered by organizations like SHM/CHEST, the ACP POCUS Pathway, and others. These can help build your skill set, but they don’t provide a clear pathway for institutional credentialing.
Institutional Process: Credentialing is often a local process and can vary significantly across institutions. Some hospitals have POCUS committees with specific criteria for diagnostic POCUS, while others leave it up to individual providers to determine their scope of practice.
Multidisciplinary Committees: If your institution has a multidisciplinary POCUS committee, they may set guidelines for privileges and guidelines for performing scans.
Scope of Practice: Depending on your specialty and institution, POCUS may fall under your existing scope of practice and its use is protected by the American Medical Association. However, it’s essential to understand local regulations and ensure that you’re compliant with institutional policies.
Understanding how to bill for POCUS is crucial for sustaining a POCUS program, especially since reimbursement can vary. While billing might seem complex and tedious, it’s an essential step toward generating revenue and ensuring that your equipment is reimbursed. Here’s what you need to know:
Key Billing Steps:
Indication and Medical Necessity: You must have a medically necessary reason for performing a POCUS exam, supported by an appropriate ICD-10 code (ex I50.2 for decompensated heart failure when doing a lung or cardiac POCUS).
Image Documentation: Ensure that at least one image from the scan is permanently stored in an available system (e.g., PACS, cloud storage, or third-party middleware). This is crucial for meeting regulatory requirements.
Interpretation and Report: Document the interpretation of the scan, including the structures evaluated, the presence or absence of relevant findings, and an overall conclusion.
CPT Codes and Modifiers: Use the correct CPT codes and any necessary modifiers to structures evaluated, the presence or absence of relevant findings, and an overall conclusion.
For instance, if you own the probe, you can bill the global fee; if you don’t, you can only bill for the professional component (using the 26 modifier).
Essential Elements for Billing:
1. A licensed provider must perform or supervise the scan.
2. An order must be placed for the ultrasound.
3. There must be a documented indication and medical necessity.
4. A written report with an interpretation of the images.
5. Permanent storage of the images.
While reimbursement for POCUS exams varies, it’s essential to understand that it’s possible to bill for both inpatient and outpatient services, provided the necessary criteria are met. In fact, a study at UNC found that the POCUS services generated over $700,000 annually in revenue, underscoring the potential financial benefit. There are also downstream cost savings associated with using POCUS, as well as inherent benefits in increased patient satisfaction.
Building a sustainable POCUS program isn’t a solo endeavor—it’s a team sport. Successful POCUS implementation requires support from multiple stakeholders, including:
A POCUS champion or credentialed provider to drive the initiative.
Clinic and hospital system leadership to ensure that infrastructure supports POCUS use.
IT and EHR departments to facilitate image storage and integration.
Industry support from equipment manufacturers to ensure that you have the right tools for success.
Incorporating POCUS into your practice requires careful consideration of several logistical factors—from selecting the right probe to navigating certification, credentialing, and billing. By focusing on the key factors such as cost, image quality, and cloud capabilities, healthcare professionals can make informed decisions when building their POCUS programs. Additionally, understanding the credentialing process, working within the scope of your practice, and mastering the billing process can help ensure the sustainability and success of your POCUS initiative.
By collaborating with colleagues and leadership across departments, you can create a robust, efficient, and financially sustainable POCUS program that enhances patient care and supports your clinical practice.