Three different bodies can credential sonographers in vascular ultrasound: the ARDMS, CCI, or the American Registry of Radiologic Technologists. Medicare in all states and territories equally recognizes the ARDMS and CCI credentials; they have a nearly equal pass/fail rate and all test on the same content. The ARRT credential is open only to qualified registered radiologic technologists and is not presently recognized by Medicare in all fifty states.
The prerequisites for the ARDMS and CCI are unique to the various entry-level backgrounds and experience. You can quickly navigate the current prerequisites through their sites.
Physicians and Abdominal/Obstetric/Breast Ultrasound
There is presently no Medicare directive requiring sonographer certification as a prerequisite to reimbursement for these procedures. Oregon, New Mexico have state laws requiring all sonographers to be credentialed to practice in any field. Other states are considering similar actions. Private insurance carriers may have separate policies.
The American Institute of Ultrasound in Medicine has recommended guidelines in place to ensure the highest standard of facility compliance. Learn more.
Physicians and Cardiac Ultrasound
Medicare is evolving its policies state by state; many states already require technologist credentialing as a condition for reimbursement. Physician credentialing is required in some, but not all states as a prerequisite to reimbursement by Medicare. Learn more.
Private payers are adopting more rigorous policies, but uniformity across the nation is still years away; ICAEL posts the most current positions of the nations largest private payers on its site here.
Eventually, the entire US will follow suit. The National Board of Echocardiography is currently the only credentialing board for doctors and prerequisites include either cardiovascular board certification or specialized postgraduate medical training in cardiovascular medicine, plus interpretation experience.
Physicians and Vascular Ultrasound (all clinical applications)
Medicare has directives throughout the entire United States that require physicians interpreting vascular ultrasound to provide evidence of specialized training, specific to the technology. Sonographers performing vascular ultrasound studies must either possess certification in vascular ultrasound or (in some states) perform the exam under the supervision of a certified sonographer.
Inspect your state’s specific Medicare policy for both physicians and technologists here. Private insurance carriers may have different policies. ICAVL no longer posts information from private insurance carriers; you will need to contact them directly for current or pending policy. In general, most require at least 10-15 hours of focused training in the specialty area.
Some states now require formal certification for physicians to read. Most hospitals‘ labs are ICAVL credentialed, which requires reading physicians to have met formal training standards in medical school or informally, by the following pathway:
- 40+ hours of Category 1 CME specific to vascular testing within the prior three years, plus
- 8 hours of supervised practical experience or observation in a credentialed vascular laboratory, and
- Documentation of 100 cases interpreted and over-read by a credentialed-lab physician, in each specialty area of application. Learn more.
Only one agency can credential primary care physicians in all areas of vascular ultrasound interpretation. As we noted above, this credential is presently required only in certain states. The American Registry of Diagnostic Medical Sonographers (ARDMS) offers the Registered Physician Vascular Interpretation credential; it has a 96% pass rate. Learn more.
Specifically Regarding Facilities Credentialing
Two separate agencies credential echocardiography and vascular laboratory services: ICAEL and ICAVL, respectively. Private offices and hospitals providing vascular ultrasound studies (whether in conjunction with echocardiography or as a standalone service) should be–and will eventually be required to be–credentialed by the appropriate agency.
The entire body of certification guidelines can now be downloaded for free: ICAEL Guidelines and ICAVL Guidelines. The process is still voluntary, and payment is still allowed in non-credentialed labs provided physician and sonographer credentialing criteria have been met. As the Affordable Care Act unfolds to its full bloom, this will inevitably evolve to a more restrictive mode.