What Unbilled POCUS Actually Costs, by Facility Size

Below are five examples, from a large academic health system down to a single family physician. Every assumption is stated and every one is adjustable. These are models rather than measurements, and you should run your own audit before taking any of them to a budget meeting.

The assumptions behind all five

Baseline billing capture: 42% of scans performed. From the most detailed published funnel study, in which 120 of 283 performed scans reached a payer (Alerhand et al. 2020).

Target billing capture: 75%. The published post-intervention figures run from 60% to 75%. Faculty participation in billing reached 75% in one study, and technical and professional billing reached 61% and 65% in another. We model the top of that range rather than the middle, because each of those studies measured a workflow in which clinicians still had to initiate documentation themselves. Where capture happens automatically at the point of scan, the remaining gap should be educational scans, non-diagnostic studies and clinical situations that defeat any workflow.

Net collected per billed study: $32 professional, $65 global. Built from 2025 Medicare national averages for the common limited codes, which run roughly $23 to $32 professional, weighted for a payer mix of approximately 45% Medicare and Medicaid, 45% commercial and 10% uncollectable.

Two warnings about this figure. It treats Medicaid as paying at Medicare rates, which is generous in most states. And it assumes a healthy revenue cycle: Alerhand’s department realised only $11.67 per billed study, because it collected on 55% of what it billed. Substitute your own realised amount per billed study before you use these numbers for anything.

One reason to treat the global figure as conservative: the facility versus non-facility distinction moves some codes a long way. Cardiac POCUS billed as 93308 pays roughly $24 as a facility professional component, and around $90 globally in an office setting, because the non-facility practice expense component is far larger. A practice whose case mix leans toward the better-paying office codes will sit above our blended figure.

A note on the source of the baseline. Alerhand’s study covers cutaneous abscess POCUS at a single urban academic emergency department, using 2017 data, in a department with both an emergency medicine residency and an ultrasound fellowship. It is one application at one site. It is used here because it is the only published study that traces the full path from scan performed to payment received, and because the archiving figures reported elsewhere are consistent with it. Treat the 42% as a starting hypothesis to test against your own data, not as a national benchmark.

Facility revenue is shown separately and cautiously. In a hospital the facility component accrues to a different entity than the professional fee, and most diagnostic ultrasound reported alongside an emergency department visit on the same claim is conditionally packaged, meaning no separate facility payment. Treat facility figures as a ceiling that most emergency departments will not approach.

1. Large academic health system

Profile: 900 beds, 100,000 ED attendances a year, POCUS in emergency, critical care, anaesthesia and hospital medicine. Around 40 probes across the enterprise.

Volume: 20,000 POCUS studies performed a year.

Per probe: roughly $9,300 a year in foregone professional revenue.

The structural problem at this tier is that nobody owns the number. The physician group loses the professional fee, the hospital loses whatever facility revenue was available, neither sees the other’s loss, and the enterprise total appears in no single report.

Device utilisation is equally unmeasured. The one enterprise deployment to publish its figures, at the University of Rochester Medical Center, reported 22,890 POCUS studies across 1,199 probes in a year (Waldman et al., J Clin Imaging Sci 2025). That works out at around 19 studies per probe, and the comparison is rough: the fleet grew from 789 to 1,199 probes during the year, so many probes were deployed for only part of it, and a separate nursing deployment generated roughly 70,000 bladder examinations over six months that sit outside the 22,890. Treat the figure as indicative. What it mainly demonstrates is that almost no US health system can produce one at all.

2. Community hospital

Profile: 300 beds, 45,000 ED attendances, 8 probes across the ED and ICU.

Volume: 2,000 POCUS studies performed a year, around 4.4% of ED attendances.

Per probe: roughly $4,600 a year.

Community emergency departments warrant a check before you run this model at all. A study across 11 non-academic emergency departments recorded 5,099 POCUS studies over two years, which the authors report as 1.03 examinations per 100 patients, or roughly 10 per 1,000 ED visits. Half that study window fell in the first COVID-19 period, which suppressed both attendances and POCUS use, so read it as a floor.

At 45,000 attendances that rate would produce around 460 studies a year rather than 2,000. A department near the community benchmark has a scanning problem before it has a capture problem, because improving the capture rate on that volume will not repay the effort. Check the device logs before the billing report.

3. Urgent care group

Profile: 6 sites, one probe per site, MSK, soft tissue, focused cardiac and limited abdominal. Practice owns the equipment and bills global.

Volume: 540 studies per site per year, around 45 a month.

Baseline is set lower here than in hospitals because urgent care rarely has an ultrasound fellowship culture, a designated POCUS lead, or an archive. Where there is no archive at all, the realistic figure falls to whatever proportion of scans someone remembered to write a labelled interpretation for. The 30% is an assumption, not a published figure.

The group total is the number to take upstairs. A six-site operator is looking at roughly half a million dollars over five years, on equipment already purchased and scans already performed.

4. Multi-physician primary care practice

Profile: 8 physicians, 2 probes, obstetric dating and viability, bladder, thyroid, MSK, focused cardiac. Practice owns the equipment.

Volume: 600 studies a year across the practice.

Per probe: roughly $13,650 a year foregone.

Primary care has the strongest per-scan economics of any tier, because global billing captures both components and several primary care codes pay well. Obstetric limited (76815) pays $78.28 global and pelvic complete (76856) pays $101.57, against professional components of around $26 for the common hospital codes.

One caution specific to this tier: bladder scanning (51798) is frequently not separately payable alongside an office visit, so a practice whose volume is bladder-heavy should model it out.

5. Single family physician

Profile: One clinician, one handheld device, mixed general practice.

Volume: 282 studies a year.

The 282 figure comes from a Butterfly Network case study describing one family physician’s annual volume. It is manufacturer marketing rather than peer-reviewed evidence, and it describes a single clinician, so treat it as a plausible order of magnitude rather than a benchmark.

On these assumptions, the revenue a solo physician fails to bill in a year sits between roughly 1.4 and 7 times the cost of the device, depending on whether the probe cost $10,000 or $2,000.

The per-probe figures, split by billing basis

Foregone revenue per probe per year separates into two groups:

• Hospital settings billing professional only: roughly $4,600 to $9,300 per probe
• Office-based settings billing global: roughly $13,650 to $24,600 per probe

The gap is explained by the technical component. A hospital-based group collecting only the professional fee earns a fraction of what a practice owning its own equipment earns for identical clinical work.

Either way, adding probes increases the capacity to perform scans without changing the proportion that reach a payer.

Where these models do not apply

• Rural Health Clinics. POCUS is bundled into the all-inclusive rate and is not separately payable. The 2025 national per-visit limit was $152 for independent RHCs and for provider-based RHCs in hospitals with 50 or more beds; other RHCs are paid differently (JABFM 2026).
• Inpatient facility billing. Technical charges are largely absorbed into the DRG. The professional component remains billable.
• Clinician-owned devices in hospitals. If the clinician owns the probe, the hospital earns no technical component regardless of documentation quality.
• Health systems without fee-for-service reimbursement for bedside ultrasound. Most systems outside the United States pay nothing marginal for a POCUS examination, and the case there rests on avoided referrals, released imaging capacity and device utilisation rather than on billing.