CMS Ultrasound Diagnostic Procedures Policy Update (NCD 263): What Billing Teams Need to Know for 2026

The Centers for Medicare & Medicaid Services has issued a modification to National Coverage Determination 263, governing ultrasound diagnostic procedures across multiple Medicare benefit categories. This update affects a broad range of specialties—from cardiology and obstetrics to radiology and vascular surgery—and clarifies which ultrasound techniques qualify for Medicare reimbursement versus those still considered experimental. If your practice bills Medicare for any diagnostic ultrasound service, this policy change deserves a close read before the March 12, 2026, effective date.

Field	Detail
Payer	CMS (Centers for Medicare & Medicaid Services)
Policy	Ultrasound Diagnostic Procedures
Policy Code	NCD 263
Change Type	Modified
Effective Date	2026-03-12
Impact Level	High
Specialties Affected	Cardiology, Radiology, Obstetrics/Gynecology, Vascular Surgery, Nephrology, Endocrinology, Pulmonology, Critical Care
Key Action	Audit your ultrasound billing workflows against the updated Category I and Category II procedure lists to ensure claims align with covered indications before the March 2026 effective date.

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What Changed in CMS NCD 263: Ultrasound Diagnostic Procedures

CMS has modified NCD 263 to reaffirm and clarify coverage boundaries for ultrasound diagnostic procedures under three Medicare benefit categories: Diagnostic Tests (other), Inpatient Hospital Services, and Physicians' Services. The policy maintains its two-category framework—Category I (nationally covered) and Category II (experimental, non-covered)—but the modification signals renewed scrutiny from A/Medicare Administrative Contractors (A/MACs) conducting periodic claims review.

For billing teams, the practical implication is straightforward: procedures in Category I are covered when general indications are met. Procedures in Category II cannot be billed to Medicare at this time. The policy is explicit that medical appropriateness and documented clinical indications are required—not just the presence of a covered procedure code.

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CMS Medicare Coverage Criteria: Category I Covered Ultrasound Procedures

Category I procedures are described by CMS as "clinically effective, usually part of initial patient evaluation" and may serve as an adjunct to radiologic and nuclear medicine diagnostic techniques. The following procedures are nationally covered under the modified NCD 263:

Echocardiography and Cardiac Ultrasound

Neurological and Ocular Ultrasound

Coverage for ocular procedures explicitly includes evaluation of aphakic patients for artificial lens implantation (pseudophakoi) following cataract surgery—a specific indication billing teams should document clearly in the medical record.

Thoracic and Pulmonary Ultrasound

#	Covered Indication Copy
1	Pleural Effusion Echography
2	Thoracentesis, by Ultrasonic Guidance

Abdominal and Retroperitoneal Ultrasound

Important limitation: Retroperitoneal Sonography does not include planning of fields for radiation therapy under this coverage category. Similarly, Abdominal Sonography is not synonymous with ultrasound examination of individual organs—a distinction that matters when billing multiple studies in a single encounter.

Renal and Urologic Ultrasound

Critical limitation: Urinary Bladder Sonography does not include staging of bladder tumors.

Obstetric and Gynecologic Ultrasound

Vascular Ultrasound

#	Covered Indication Copy
1	Arterial Flow Study, Peripheral (Doppler)
2	Venous Flow Study, Peripheral (Doppler)
3	Arterial Aneurysm, Peripheral (B-Scan)

Thyroid and Breast Ultrasound

Radiation Therapy Planning

#	Covered Indication Copy
1	Radiation Therapy Planning Sonography (B-Scan)

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Non-Covered Procedures: CMS Category II Experimental Ultrasound Techniques

Category II procedures are explicitly designated as experimental under NCD 263 and should not be billed to Medicare. The policy does not enumerate a comprehensive list in the excerpt available, but A/MAC medical consultants are directed to conduct periodic claims review to verify that submitted claims reflect Category I procedures meeting documented indications—not Category II experimental techniques.

If your practice has been billing ultrasound-guided procedures or newer ultrasound modalities that don't map clearly to the Category I list above, treat those as high-risk claims pending further contractor guidance.

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A/MAC Claims Review: What "Periodic Review" Means for Your Practice

The policy directs A/MAC medical consultants to conduct periodic claims review to confirm two things: that the ultrasound technique used is medically appropriate and that the general indications specified in Category I are met. This isn't a one-time audit trigger—it's an ongoing compliance obligation.

For revenue cycle teams, this means documentation standards matter as much as the procedure itself. A claim for Pancreas Sonography (B-Scan) should reflect clinical indications consistent with diagnosing conditions like pseudocysts. A claim for Abdominal Sonography should not be used as a proxy for billing individual organ examinations separately.

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Affected Codes

The updated NCD 263 policy does not list specific CPT or HCPCS codes within the policy document itself. CMS describes covered services by procedure name and modality type rather than by numeric code assignment. Billing teams should cross-reference the procedure descriptions above against their internal CPT code mapping and consult their A/MAC for code-to-procedure alignment guidance.

There are no ICD-10-CM diagnosis codes specified in this policy document.

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What Your Billing Team Should Do

Copy Action Items

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