CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPO30

Point-of-Care Ultrasound (POCUS) Examination Policy

Governs reimbursement and coding expectations for point-of-care ultrasound examinations performed by facilities and qualified providers for Blue Cross Blue Shield of New Mexico members, including documentation, modifier use, and distinctions between limited and complete studies.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyPoint-of-Care Ultrasound (POCUS) Examination Policy

Policy CodePolicy CPCPO30

Change TypeAnnual review (no material change)

Effective DateSep 12, 2023

Next Review Date

Key ActionSubmit permanently recorded images and a final written report with claims; BCBSNM may request supporting documentation to determine reimbursement.

SourceLink

POLICY UPDATE CHANGES

Annual review noted on 09/05/2023 per approval date and effective date of the policy.

2023-09-12effective date

1.0policy version

2023-09-05committee approval

2020-2023policy history

POCUS Coverage and Billing Rules

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyPoint-of-Care Ultrasound (POCUS) Examination Policy

Policy CodePolicy CPCPO30

Change TypeAnnual review (no material change)

Effective DateSep 12, 2023

Next Review Date

Key ActionSubmit permanently recorded images and a final written report with claims; BCBSNM may request supporting documentation to determine reimbursement.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

ALL of the following

Providers must submit claims using valid HIPAA-approved code sets and appropriate code combinations per industry coding guidelines.
All images must be permanently recorded and documented in the member's medical record, with indications, results, and a final written report; documentation may be requested by the plan to determine reimbursement.
When point-of-care ultrasound (POCUS) is used as part of an evaluation and is not a standalone/dedicated procedure (for example, integral to an E/M visit), it is considered integral to the exam and cannot be submitted separately for reimbursement.
Ultrasound procedures include technical (TC) and professional (PC) components: append modifier -TC for the technical component and modifier -26 for the professional component; a global procedure (both TC and PC) may be billed without those modifiers when the same provider performs and interprets the service under the same facility arrangement.
Limited and complete ultrasound examinations are real-time studies and should include permanently recorded images; a POCUS without thorough evaluation, image documentation, and a final written report is not separately reportable.
If no specific CPT exists for a limited ultrasound examination, report the complete ultrasound study with modifier -52 to indicate reduced service.
Payment for listed codes is not guaranteed; payment depends on applicable plan documents and the provider/facility documentation. BCBSNM may request supporting documentation and will review claims on a case-by-case basis.

Examples (not exhaustive)

Clinical examples of emergency/point-of-care ultrasound indications include: adnexal pathology, early obstetric assessment, ENT, infectious disease, musculoskeletal, ocular, testicular, transcranial Doppler, transesophageal echo, trauma, and vascular studies.

Coding examples (not exhaustive)

Example CPT/HCPCS codes referenced in this policy include head and neck (e.g., 76506), chest (e.g., 76604), abdomen (e.g., 76700), spinal canal (76800), pelvis/obstetrical (76801, 76805, etc.), extremities (76881), and ultrasonic guidance/other procedures (e.g., 76932, 76999). Codes listed do not guarantee payment.

Billing operational notes

Facilities and providers are responsible for submitting appropriate codes and modifiers for services rendered during point-of-care ultrasound examinations; failure to adhere to coding and billing policies may impact claims processing and reimbursement.
The plan reserves the right to request supporting documentation; claims may be reviewed and adjudicated on a case-by-case basis.

Modifier guidance

Append modifier -TC to identify the technical component and modifier -26 to identify the professional component. When the same provider both performs and interprets the study under the same facility arrangement, the global procedure may be billed without appending these modifiers.

When to report -52

If there is no specific CPT for a limited ultrasound examination, report the complete study with modifier -52 to indicate a reduced service.

Example CPT/HCPCS Codes and Documentation Requirements

Example POCUS and related ultrasound CPT/HCPCS codes (not exhaustive)CPT

76506	Head and neck ultrasound (example list)
76510	Head and neck ultrasound (example list)
76511	Head and neck ultrasound (example list)
76512	Head and neck ultrasound (example list)
76513	Head and neck ultrasound (example list)
76514	Head and neck ultrasound (example list)
76516	Head and neck ultrasound (example list)
76519	Head and neck ultrasound (example list)
76529	Head and neck ultrasound (example list)
76536	Head and neck ultrasound (example list)

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Image documentation requirement

RequirementPOCUS and limited/complete ultrasound examinations must include permanently recorded real-time images saved to the medical record and a final written report; without image documentation and a final written report, POCUS is not separately reportable.

Impact on BillabilityIf the study lacks permanently recorded images and a final written report, the POCUS cannot be submitted as a separate reimbursable procedure.

Medical Record ExpectationImages and the written report should be included in the member's medical record and may be requested by BCBSNM to determine reimbursement.

Provider Billing Guidance and Plan Discretion

Documentation Required

Documentation and Plan Discretion — BCBSNM may request additional documentation

If a conflict exists between this Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern. If a conflict exists between this policy and any provider contract, the provider contract will govern. "Plan documents" include, but are not limited to, Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents. BCBSNM may use reasonable discretion in interpreting and applying this policy to services delivered in a particular case and has full and final discretionary authority for interpretation and application to the extent provided under any applicable plan documents. Providers are responsible for submitting accurate documentation of services performed and should submit claims using valid HIPAA-approved code sets and industry-standard coding guidelines. Claims are subject to code edit protocols and review against provider contract language, medical policies, and coding software logic. Upon request, the provider must submit any additional documentation to support payment.

Providers should retain and submit supporting medical records when requested.
Claims may be reviewed on a case-by-case basis and reimbursement determined per applicable plan documents and documentation provided.

Billing Rule

POCUS Integral to E/M — when POCUS is part of the E/M it is not separately billable

When point-of-care ultrasound (POCUS) is performed as part of an Evaluation & Management (E/M) visit and is integral to the E/M service (i.e., not a standalone/dedicated ultrasound procedure), the ultrasound is considered part of the E/M and is not separately billable. Providers should document the POCUS images, indications, results, and clinical impression in the member's medical record. The plan reserves the right to request supporting documentation to determine eligibility for reimbursement.

Affected CPTs commonly used for point-of-care ultrasound guidance and procedures include: 76932, 76936, 76937, 76940-76942, 76945, 76946, 76948, 76965, 76975, 76977-76979, 76981-76983, 76998-76999.
When POCUS is a dedicated/standalone ultrasound study billed separately, submit appropriate ultrasound procedure codes and documentation; when POCUS is integral to an E/M, do NOT bill separately for the ultrasound.

Key Terms and Modifiers

POCUS — point-of-care ultrasound

DefinitionPoint-of-care ultrasound (POCUS) is an examination performed by an appropriately trained qualified provider using a portable ultrasound device to diagnose and treat a medical problem in real time.

PurposeIntended to provide real-time evaluation and management at the bedside, not to replace a formal radiology-performed ultrasound.

SettingCommonly used in acute or critical care settings (for example emergency department evaluations).

TC/PC modifiers

Technical component (-TC)Identifies the performance of the test (the technical component) and is reported by appending modifier -TC.

Professional component (-26)Identifies the interpretation of the test and the documented written report (the professional component) and is reported by appending modifier -26.

Global procedureA global procedure contains both TC and PC and may be billed without appending modifiers when the same provider performs and interprets the service under the same facility arrangement.

Limited vs Complete Ultrasound

Complete ultrasoundA complete ultrasound examination evaluates all the major structures of an anatomical location and is performed in real time with permanently recorded images.

Limited ultrasoundA limited ultrasound examination evaluates a specific area for a defined condition, is performed in real time, and should include permanently recorded images.

When CPT absentIf no CPT code exists for a limited ultrasound, report the complete study with modifier -52 to indicate reduced service.