**B. Nationally Covered Indications**

Category I - (Clinically effective, usually part of initial patient
evaluation, may be an adjunct to radiologic and nuclear medicine diagnostic
technique)

  * Echoencephalography, (Diencephalic Midline) (A-Mode).
  * Echoencephalography, Complete (Diencephalic Midline and Ventricular Size).
  * Ocular and Orbital Echography (A-Mode).
  * Covered procedures include efforts to determine the suitability of aphakic patients for implantation of an artificial lens (pseudophakoi) following cataract surgery.
  * Ocular and Orbital Sonography (B-Mode).
  * Echocardiography, Pericardial Effusion (M-Mode).
  * Pericardiocentesis, by Ultrasonic Guidance.
  * Echocardiography, Cardiac Valve(s) (M-Mode).
  * Echocardiography, Complete (M-Mode).
  * Echocardiography, limited (e.g., follow-up or limited study) (M-Mode).
  * Pleural Effusion Echography.
  * Thoracentesis, by Ultrasonic Guidance.
  * Abdominal Sonography, complete survey study (B-Scan).
  * Abdominal Sonography, limited (e.g., follow-up or limited study) (B-Scan).
  * Abdominal Sonography is not synonymous with ultrasound examination of individual organs.
  * Renal Cyst Aspiration, by Ultrasonic Guidance.
  * Renal Biopsy, by Ultrasonic Guidance.
  * Pancreas Sonography (B-Scan).
  * Pancreatic Sonography has proven effective in diagnosing pseudocysts.
  * Spleen Sonography (B-Scan).
  * Abdominal Aorta Echography (A-Mode).
  * Abdominal Aorta Sonography (B-Scan).
  * Retroperitoneal Sonography (B-Scan).
  * Retroperitoneal Sonography does not include planning of fields for radiation therapy.
  * Urinary Bladder Sonography (B-Scan).
  * Urinary bladder Sonography does not include staging of bladder tumors.
  * Pregnancy Diagnosis Sonography (B-Scan).
  * Fetal Age Determination (Biparietal Diameter) Sonography (B-Scan).
  * Fetal Growth Rate Sonography (B-Scan).
  * Placenta Localization Sonography (B-Scan).
  * Pregnancy Sonography, Complete (B-Scan).
  * Molar Pregnancy Diagnosis Sonography (B-Scan).
  * Ectopic Pregnancy Diagnosis Sonography (B-Scan).
  * Passive Testing (Antepartum Monitoring of Fetal Heart Rate In the Resting Fetus).
  * Intrauterine Contraceptive Device Sonography (B-Scan).
  * Pelvic Mass Diagnosis Sonography (B-Scan).
  * Amniocentesis, by Ultrasonic Guidance.
  * Arterial Flow Study, Peripheral (Doppler).
  * Venous Flow Study, Peripheral (Doppler).
  * Arterial Aneurysm, Peripheral (B-Scan).
  * Radiation Therapy Planning Sonography (B-Scan).
  * Thyroid Echography (A-Mode).
  * Thyroid Sonography (B-Scan).
  * Breast Echography (A-Mode).
  * Breast Sonography (B-Scan).
  * Hepatic Sonography (B-Scan).
  * Gallbladder Sonography.
  * Renal Sonography.
  * Two-Dimensional Echocardiography (B-Mode).
  * Monitoring of cardiac output (Esophageal Doppler) for ventilated patients in the ICU and operative patients with a need for intra-operative fluid optimization

**C. Nationally Non-Covered Indications**

Category II - (Clinical reliability and efficacy not proven):

  * B-Scan for atherosclerotic narrowing of peripheral arteries.

**D. Other**

Uses for ultrasound diagnostic procedures not listed in Category I or II above
are left to local MAC discretion. In view of the rapid changes in the field of
ultrasound diagnosis, uses for ultrasound diagnostic procedures other than
those listed under Categories I and II should be carefully reviewed before
payment. Medical justification may be required.

(This NCD last reviewed June 2007.)