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Medicare spending on imaging services, among which are ultrasound procedures that use sound waves to facilitate diagnosis, nearly doubled from 1999 to 2004. The Congress required GAO to examine Medicare's payment methods for ultrasound procedures and whether the technicians that conduct them--called sonographers--should be subject to qualification standards, such as having to undergo a certification process called credentialing. This report addresses (1) the ultrasound procedures commonly used to diagnose medical conditions of Medicare beneficiaries, particularly for beneficiaries in a skilled nursing facility (SNF), (2) the financial impact of changing how Medicare pays for ultrasound exams and associated equipment and ambulance transportation for beneficiaries in a SNF, and (3) the factors for the Centers for Medicare & Medicaid Services (CMS) to consider in determining whether to establish credentialing or other requirements for sonographers. For this review, GAO analyzed Medicare claims data and conducted interviews and literature reviews.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services The Administrator of CMS should require that sonographers paid by Medicare either be credentialed or work in an accredited facility. The Administrator should weigh the advantages and disadvantages of implementing a National Coverage Determination compared with promulgating regulations that this requirement be a condition for Medicare payment.
Closed - Not Implemented
In its written comments on a draft of this report, CMS stated that it would consider our recommendation that sonographers furnishing services to Medicare beneficiaries either be credentialed or work in an accredited facility, but it would prefer to have states engage their own licensing bodies in implementing sonographer licensing programs that address competency and qualification issues. CMS indicated in 2009 that it did not plan to implement this recommendation.

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