A breast ultrasound is a non-invasive diagnostic tool that uses high-frequency sound waves to create images of the internal structures of the breast. This procedure is frequently used to investigate abnormalities found during a mammogram or a physical exam, such as a palpable lump, to determine if it is a fluid-filled cyst or a solid mass. Because it does not use ionizing radiation, it is a safe option for younger patients, pregnant individuals, or those with dense breast tissue where mammography images can be more challenging to read. This guide outlines the steps needed to obtain a breast ultrasound, from identifying a facility to navigating the financial landscape.
Types of Facilities and Locations
Patients seeking a breast ultrasound typically have three types of facilities to choose from. Large hospital systems offer breast imaging services, often providing the benefit of integrated care, where results can be easily shared with other specialists within the same network. These sites often have 24/7 access for urgent cases and a wide range of other diagnostic and surgical services available.
Dedicated breast centers are specialized facilities that focus exclusively on breast health and imaging. These centers often feature specialized equipment and staff, including radiologists and technologists whose practice is focused entirely on breast imaging. Many of these dedicated centers also hold accreditations, such as the American College of Radiology (ACR) Breast Imaging Center of Excellence designation, which signifies adherence to high practice standards.
The third option is a standalone or outpatient imaging center, which can provide a more convenient and often quicker scheduling experience. These centers are typically focused on efficiency and may offer a lower cost for the procedure compared to a hospital-based setting. However, they may be less integrated with a patient’s primary care physician, requiring the patient to ensure proper transfer of imaging results and reports.
Necessary Steps for Scheduling and Access
Obtaining a breast ultrasound nearly always begins with a physician’s order, as it is considered a diagnostic procedure rather than a routine screening. This referral is mandatory for scheduling and insurance coverage verification. The referral document should specify the exact reason for the scan, such as “palpable lump” or “abnormality seen on mammogram,” which determines whether the scan is coded as a diagnostic or a screening procedure.
Once the order is secured, the patient must contact the imaging facility to schedule the appointment. During scheduling, the facility will require information about the referring physician and the specific reason for the exam. It is also highly recommended that patients confirm the facility’s quality standards by checking for accreditations, especially from organizations like the ACR, which reviews personnel qualifications, equipment quality, and image quality.
The facility requires the patient’s medical history and any previous relevant imaging, such as prior mammograms or ultrasounds, to be sent before the appointment. This previous history is essential for the radiologist to compare the new images against, a process that helps accurately evaluate any changes in the breast tissue. The scheduling staff will also usually initiate the pre-authorization process with the patient’s insurance company based on the physician’s order.
Financial Considerations and Insurance Coverage
The financial obligation for a breast ultrasound depends heavily on how the procedure is coded and the patient’s specific insurance plan. Breast ultrasounds are generally classified as diagnostic tests when they are used to investigate a symptom or a finding from another exam. Most insurance plans, including Medicare, cover diagnostic ultrasounds, but this coverage typically involves patient cost-sharing through deductibles, copayments, or co-insurance.
Patients must contact their insurance provider before the appointment to verify that the chosen facility is considered “in-network” to avoid significantly higher out-of-pocket costs. They should also inquire about the specific Current Procedural Terminology (CPT) code used for the procedure. For example, a diagnostic ultrasound after an abnormal mammogram will be covered differently than a whole-breast screening ultrasound performed solely due to dense breast tissue.
If a pre-authorization is required by the insurance plan, the ordering physician’s office is usually responsible for submitting the necessary documentation. For individuals without insurance or those facing high deductibles, the option of self-pay is available, and prices can vary widely. Patients should proactively discuss the expected cost with the facility’s billing department and ask about potential financial assistance programs or self-pay discounts before the procedure.