Echocardiography Advanced Diagnostic Imaging Classification 

Background

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires suppliers of advanced diagnostic imaging (ADI) services to be accredited by a CMS-designated organization to receive Medicare reimbursement. Section 1834(e)(1)(B) of the Social Security Act defines ADI services as diagnostic MRI, CT, and nuclear medicine, explicitly excluding ultrasound. This means echocardiography falls outside the ADI framework despite providing high-resolution cardiac images with sophisticated Doppler, strain, and 3D/4D capabilities comparable in complexity to recognized advanced modalities.

The Quality Gap

Because echocardiography is excluded from the ADI classification, non-specialists without cardiac imaging expertise can perform complex echocardiograms without meeting the accreditation standards required of MRI, CT, and nuclear medicine providers. This creates inconsistent imaging quality across facilities, increased risks of misdiagnosis, and unnecessary repeat testing when initial studies are substandard. The accreditation framework MIPPA established for other advanced modalities, including personnel qualifications, equipment standards, and image quality procedures, does not apply to echocardiography.

ASE Recommendations

ASE urges Congress to amend Section 1834(e)(1)(B) of the Social Security Act to include echocardiography as an advanced diagnostic imaging service. This change would:

• Establish mandatory accreditation for all suppliers performing echocardiography, consistent with standards for MRI, CT, and nuclear medicine
• Ensure qualified specialists with appropriate training perform and interpret these cardiovascular diagnostics
• Implement utilization controls to reduce unnecessary and duplicative testing
• Improve patient outcomes through uniform quality standards while reducing costs driven by misdiagnoses and inadequate oversight