Exam Requirements: Vascular Ultrasound (Revised 7-13-2026)

Exam Requirements: Peripheral Arterial

Lower Extremities - Arterial Duplex

*A bilateral exam should be submitted

Longitudinal gray scale images 

• Common femoral artery

• Proximal profunda femoris artery

• Superficial femoral artery - proximal, mid, and distal

• Popliteal artery - proximal and distal

• Anterior tibial artery

• Posterior tibial artery - distal 

• Dorsalis pedis artery

Longitudinal stand-alone color Doppler images

• Common femoral artery

• Proximal profunda femoris artery

• Superficial femoral artery - proximal, mid, and distal

• Popliteal artery - proximal and distal

• Anterior tibial artery

• Posterior tibial artery - distal

• Dorsalis pedis artery

Longitudinal spectral Doppler waveform with color Doppler evaluation

• Common femoral artery

• Proximal profunda femoris artery

• Superficial femoral artery - proximal, mid, and distal

• Popliteal artery - proximal and distal

• Anterior tibial artery

• Posterior tibial artery - distal

• Dorsalis pedis artery

Exam Requirements: Peripheral Venous

Lower Extremities - Venous

Lower Extremities - Venous Insufficiency

A bilateral exam should be submitted

Static transverse gray scale images without and with compression OR transverse gray scale cine clips without and with compression

• Common femoral vein - superior to and separate from the saphenofemoral junction

• Saphenofemoral junction

• Proximal profunda femoris vein

• Femoral vein – proximal, mid, and distal

• Popliteal vein

Longitudinal color and/or spectral Doppler waveform images

• Saphenofemoral junction

• Proximal profunda femoris vein

• Femoral vein – proximal, mid, and distal

Spectral Doppler waveform demonstrating spontaneous flow and respiratory phasicity

• Common femoral vein or external iliac vein

• Popliteal vein

**Effective 1/1/2027** - The above requirement will state "Longitudinal color with spectral Doppler waveform demonstrating spontaneous flow and respiratory phasicity"

Static transverse gray scale images without and with compression OR transverse gray scale cine clips without and with compression. 

• Common femoral vein - superior to and separate from the saphenofemoral junction

• Saphenofemoral junction

• Proximal profunda femoris vein

• Femoral vein - proximal, mid, and distal

• Popliteal vein

Documentation of direction of flow to include longitudinal color with spectral Doppler waveform following augmentation maneuvers or Valsalva (in the upper thigh) with the patient in the semi-upright or upright position. Length of time of reflux must be measured in at least one location within the superficial system.

• Common femoral vein

• Saphenofemoral junction

• Proximal profunda femoris vein

• Femoral vein - proximal, mid, and distal

• Popliteal vein

• Great saphenous vein including saphenofemoral junction and throughout thigh at a minimum (proximal, mid and distal)

• Inferior to knee

  • Great saphenous vein - below the knee

  • Small saphenous vein

Exam Requirements: Cerebrovascular

Extracranial Carotid

Transverse gray scale images

• Common carotid artery – proximal and distal

• Bifurcation

Longitudinal gray scale images

• Common carotid artery – proximal and distal

• Internal carotid artery – proximal

• External carotid artery – proximal

Longitudinal stand-alone color Doppler images

• Common carotid artery – proximal and distal

• Internal carotid artery – proximal

• External carotid artery – proximal

Longitudinal spectral Doppler waveform with color Doppler evaluation

• Common carotid artery – proximal and distal

• Internal carotid artery – proximal, mid, and distal 

• External carotid artery – proximal

• Vertebral artery

Exam Requirements: Liver Vasculature

Complete gray scale documentation in longitudinal

• At least three gray scale images of the left lobe to include lateral, mid, medial

• At least three gray scale images of the right lobe to include lateral, mid, medial  

Complete gray scale documentation in transverse

• At least three gray scale images of the left lobe to include superior, mid, inferior

• At least three gray scale images of the right lobe to include superior, mid, inferior

Gray scale images of vascular anatomy including vessel labeling

• Portal veins – main, right, and left

• Hepatic veins – right, middle, and left

• Inferior vena cava

• Splenic vein – posterior to pancreas

Longitudinal stand-alone color or power Doppler images

• Portal veins - main, right, and left

• Hepatic veins – right, middle, and left

• Hepatic artery

• Inferior vena cava

• Splenic vein - posterior to pancreas

Spectral Doppler waveform with color Doppler evaluation

• Portal veins – main (angle correction required), right, and left

• Hepatic veins - right, middle, and left

• Hepatic artery (angle correction required)

• Inferior vena cava

• Splenic vein – posterior to pancreas

Exam Requirements: Renal Vasculature

*Both kidneys MUST be present

Complete gray scale documentation of kidneys in longitudinal 

• At least three gray scale images to include lateral, mid without measurement, medial

                                                                        OR

• Longitudinal gray scale cine clip from medial to lateral throughout both kidneys

• At least one static gray scale image of each kidney (mid kidney) in longitudinal without measurement

Complete gray scale documentation of kidneys in transverse 

• At least three gray scale images to include upper pole, mid without measurement, lower pole

                                                                       OR

• Transverse gray scale cine clip from superior to inferior throughout both kidneys

• At least one static gray scale image of each kidney (mid kidney) in transverse without measurement

Renal length

Spectral Doppler waveform with color Doppler evaluation 

• Aorta (angle correction required) - at or just above the origin of the renal arteries

• Main renal artery (angle correction required) - proximal, mid, and distal

• Main renal vein

• Upper and lower pole segmental or interlobar arteries documenting RI or AI/AT

Exam Requirements: Aorta

Longitudinal gray scale images without and with AP measurements

• Aorta – proximal, mid, and distal

• Right common iliac artery

• Left common iliac artery

Transverse gray scale images without and with transverse measurements

• Aorta – proximal, mid, and distal

• Proximal common iliac arteries

Longitudinal color and/or spectral Doppler waveform of the distal aorta

12-12-19

All

Article created; FAQs incorporated; No criteria changes

3-13-2020

Diagnostic Criteria

The submission of diagnostic criteria has been removed and is no longer required.

6-2-2020

Added complete documentation description

8-4-2020

Exam Requirements: Abdominal Ultrasound

Additional documentation clarification for liver vasculature, liver transplantation, TIPS, renal artery stenosis, renal vein thrombosis and renal transplant (renal artery thrombosis) exams.

10-15-2020

Removed and/or after abdominal (Liver or Renal) for clarification purposes

10-30-2020

Liver Vasculature

Changed main portal vein to portal veins- main, right and left

2-16-21

Aorta

longitudinal gray scale images without and with AP measurements and transverse gray scale images without and with transverse measurements

4-20-21

Renal Transplant (Renal Artery Thrombosis)

Changed kidneys to transplanted kidney

1-21-2022

Updated exam requirements

5-10-2022

Thrombosis- Upper Extremities

Aligned all bullets under transverse gray scale without and with compression

11-9-2022

All

Updated exam requirements

3-10-2023

Renal Vasculature 

Clarified spectral Doppler waveform

Liver Vasculature

Clarified Doppler images

Aorta

Added longitudinal for color and/or spectral Doppler

10-13-2023

Peripheral Venous

Clarified lower extremities-venous insufficiency needs documentation of direction of flow with longitudinal color and spectral Doppler waveform

8-23-2024

Added link to the Modalities with Low Volume or Emergency Use article

Lower Extremity-Venous Insufficiency

Added proximal, mid and distal description for the great saphenous vein

7-13-2026

Renal Vasculature

Removed the Renal Artery Stenosis exam name and cine clip options are included for the gray scale evaluation of the kidneys

Lower Extremity -  Venous

Added requirement that goes into effect on 1/1/2027

Lower Extremity - Venous Insufficiency 

Clarified language in the Documentation of direction of flow section of the requirements to say color with spectral Doppler waveform