Podiatry Ultrasound: Common Exams & Reimbursements

The short video below will provide you with an introduction to the most common podiatry ultrasound applications you will want to perform and what they reimburse.

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Update: Since this video was recorded, a few changes have occured. First, the code for diagnostic exams is now split into two different codes, one for basic exams (say a 30-second plantar fascia exam, which now reimburses between $25 and $50) and one for a "complete" exam (typically requiring more than one image or angle, for example around the ankle or any joint, which now reimburses about $75 to $125). Guided injections remain the same, however, with CPT 76942. And even with the reduced reimbursements, one injection, one "complete" exam, and one basic exam per day, even 4 days a week, should translate to about $56K a year, which would be about 8X your investment.)

Foot and Ankle Ultrasound — An Indispensable Tool ...

When you add ultrasound to your podiatry practice, you will initially gravitate to a core arsenal or repertoire of standard ultrasound exams and ultrasound-assisted procedures. Plantar fasciitis exams will be your first and most obvious application, where you are simply identifying inflammation and making measurements of the thickness of the fascia, checking for heel spurs, and looking for ruptures or tears to the fascia. Given how common this procedure is, you will likely use plantar fascia exams to master your work flow and develop your skills at the primary techniques. Very soon, however, you will expand to other materials in the training package, study more of the training videos, and move on to additional procedures and ever more refined distinctions.

An Outline of the Most Common Podiatry Ultrasound Exams

Plantar Fascia Exams

Distinguishing between plantar fasciitis, plantar fibromas, heel spurs, and other heel pad injuries.
Differentiating between plantar fasciitis and plantar fasciosis (the one being acute, the other chronic).
Checking for tears or ruptures of the fascia, and examining for hematoma and other trauma.

Tendon Exams

Checking for inflammation or tears and ruptures of the Achilles and PT tendons, and investigating other trauma.
Ascertaining the extent and severity of ligament strains and tears, periarticular swelling, etc.

Other Exams and Procedures

Differentiating between a neuroma and capsulitis.
Identifying various soft-tissue tumors and cysts.
Inspecting foreign bodies.
Measuring (and monitoring the healing process of) ulcers and lesions, and checking wounds for deep trauma or tunneling.
Delivering intra-articular and intra-lesional injections.
Conducting biopsies of deep masses and abscesses.
Aspirating fluid-filled masses not fully palpable.
Eliminating the need for otherwise-unnecessary MRI's.

Standard Reimbursements for Podiatry Ultrasound Procedures

All standard musculoskeletal ultrasound exams are billed under CPT code 76880. The average Medicare reimbursement nationwide is $95. We see private insurance reimbursing more on the order of $125. (In other words, if you were to estimate $100 per exam, and performed one 5-minute plantar fascia exam in the morning and one 5-minute neuroma exam in the afternoon, five days a week, you would earn over $50,000 a year.)

Now, if you bring a needle into it — whether a guided injection, a biopsy, or an aspiration — you would instead bill the CPT code 76942. The average Medicare reimbursement here would be $150, although we see typical reimbursements averaging nearer $175. This would be on top of whatever you normally charge for the injection, of course. (In other words, even if you estimate only $150 per guided injection, and performed merely one per day, five days a week, you would add another $37,500 a year to your practice.)

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