Sonography Licensure FAQs

(Frequently Asked Questions regarding Sonography Licensure)

Four states, New Hampshire, New Mexico, North Dakota, and Oregon, have recently approved legislation mandating the licensure of medical sonographers, along with other imaging allied health professionals. As a result, ASE asked members for comments about licensure.  The following is a sample of frequently asked questions and ASE responses.

What is the difference between licensure, registry, credentialing and certification?

Licensure is commonly thought of as legal permission granted by a designated governmental authority to engage in an activity. Generally, licensure regulations define professional scope of practice; minimum requirements to practice; disciplinary enforcement; and the composition of a government appointed board.

Registry is typically a list of individuals who perform a set of activities within a minimum scope of work. Credentialing involves passing an examination related to a field of subject matter and practice and receiving recognition of passing such an exam by a private agency. (This is the current process run by ARDMS and CCI.)  Certification is a broad term for giving certificates to individuals in certain situations. This can be legally applied to demonstrate that those who receive the certificate can perform specific tasks.

What is ASE’s involvement with licensure?

ASE is ensuring that we are in discussions with any state body which is considering licensure of sonographers. ASE’s leadership has determined that the best course of action is to be involved in the process from the beginning, working to affect an outcome that is best for our profession and our patients.

If licensure bills were to pass, what minimum standards would be used to demonstrate the ability to be licensed?

Minimum standards are part of the discussion of the language of any legislative bill. The ASE strongly suggests that the current method of credentialing through ARDMS and CCI be used as a minimum standard to apply for a license.

Will I have to be credentialed to be licensed, and isn’t this double the work?

ASE supports a process whereby sonographers will need to pass the credentialing exam and then apply to the state by simply providing proof of that credential, filling out a form and paying a small annual state licensure fee.

What will happen if I am not credentialed in a state that requires licensure?

It is anticipated that any licensure bill that links the credentialing process with licensure will give a notification period to allow those practicing in the field to become credentialed. If they do not get the credential in that time period, it may become illegal for them to practice sonography.

Will the process of being licensed cost me more?

If the process follows other allied health professions license process, it is expected there will an annual fee similar to that for a driver’s license which will need to be paid.

Is it possible that if a state requires licensure it will cause an increase in the salaries of sonographers?

Some have suggested that one of the pros of licensure is a broader recognition of the profession, which may increase salaries.  Considering the current climate of the ical profession this may be unlikely, as imaging has been targeted for cuts in reimbursement, and this may translate to diminishing resources in the future.

How will licensure affect the ultrasound schools?

If passed, licensure is likely to raise the bar of all areas of sonography education and standard setting. It is thought that licensure will use credentialing to prove qualifications, and in turn there may be language that requires the credentialing bodies to require a high educational standard such as attendance of a CAHEEP ultrasound educational program.

Will there be grandfathering in as a qualification of becoming licensed?

It is not the normal process of licensure legislation to grandfather individuals in based on years of experience. It is more likely that the legislation will provide a relatively long time for individuals to meet the minimum qualifications, such as passing a credentialing exam.

Will other states likely follow the lead of Oregon, New Mexico, and North Dakota and try to pass licensure legislation?

It is not uncommon for one state to follow another’s legislative actions, especially if they are shown to be beneficial to the public.  In addition, licensure may be seen to provide another revenue source for the state and this may be very attractive in the current economic climate.

If multiple states pass licensure requirements, will sonographers be able to practice in multiple states?

The idea of reciprocity to qualify and work in multiple states as part of licensure is important. The ASE strongly supports this concept and will work to have this written into licensure legislation.

Are there any other cons to licensure?

There is a fear that licensure would increase the sonography shortage by making it difficult for those who do not meet the minimum qualifications or by making it more difficult to start down the educational pathway of sonography.  In addition, there is always potential that a licensure bill may not accurately represent the cardiovascular sonography profession, i.e. by having inappropriate standards or when the composition of the board doesn’t reflect the cardiovascular community.

Are there any other pros to licensure?

Certainly the main push for licensure from the lay public and legislators is the thought that licensure will decrease the potential harm to the public by weeding out individuals who practice below standards and who theoretically have the potential to cause harm.  For instance, the Oregon bill is strongly supported by legislators who feel that all health professionals need to pass background checks before being entrusted with access to patients.

Many states require that only a licensed professional be allowed to start intravenous lines.  In these states, licensed sonographers will be allowed to start IVs with the proper training.
Licensure may also bring credibility and professional legitimacy to the sonography profession.

Where can I find information about the Oregon licensure bill?

You can visit the Oregon Board of Radiologic Technology Website at to see the latest draft legislation and updates from the meetings.

Who do I contact to be more actively involved with ASE’s advocacy efforts about licensure?

Contact Irene Butler, ASE’s Vice President of Health Policy, at

Where can I send comments to ASE about my concerns or support for licensure?

You can also continue to send your questions and comments to the following:

ASE Headquarters – COVID-19 Update

Beginning March 26, 2020, the county where the ASE Headquarters is located is under a government order to “Stay at Home” due to the spread of the coronavirus. These “Stay at Home” recommendations continue to be in effect and depend on the infection rates in the County/State. ASE will keep all but essential personnel telecommuting until a time when it is judged safe to return to work. We are not suspending or closing operations; our employees will remain working and providing excellent customer service to our members and the cardiovascular ultrasound community. However, ASE will slightly modify its official open hours to 9 AM – 4 PM Eastern TimeMonday-Friday. Should you need to get in touch with a staff person, call our main office at 919-861-5574 and a phone list by department will be available. A staff directory is also available here. All general questions can also be sent through Thank you and our best wishes for your continued safety.

New 3D Imaging Code Survey Needs U.S. Physician Input

This is your opportunity to participate in the Relative Value Update Committee (RUC) process to ensure fair and adequate code valuation. The proposed CPT add-on code that describes the additional work required for 3D imaging, in addition to the base echocardiography service, is currently under review at the AMA RUC. Your participation in the RUC survey process is key in the assessment of the time, complexity, and physician work value for these procedures. If you were randomly selected, you received an email from “Qualtrics” with the subject line, “AMA RUC Survey – 3D Imaging of Cardiac Structures.” We ask you to look for it in all your email folders, as many members have found the survey in their spam/junk folder.

More information about the RUC and the survey process is available here.The AMA has created a video to explain the purpose of the survey process and provide specific instructions on how to complete the survey accurately. Please contact Irene Butler, ASE’s Vice President of Health Policy & Member Relations at, with any questions. We greatly appreciate your time, input, and expertise.