CMS Nonobstetric Pelvic Ultrasound Form

Summary Of Evidence

N/A

Analysis of Evidence

N/A

Indications

 Pelvic pain undiagnosed by standard exam:

1. Dysmenorrhea
2. Menorrhagia
3. Metrorrhagia
4. Menometrorrhagia
5. Postmenopausal bleeding
6. Abnormal pelvic examination
7. Further evaluation of abnormality found on other imaging studies
8. Cancer

Limitations 

The accuracy of ultrasonographic studies depends on the knowledge, skills and experience of the technologist and interpreter. Consequently, the providers of interpretations must be capable of demonstrating documented training and experience and maintain documentation of such for possible audit. Further, ultrasonographic studies must be either (1) performed by persons with appropriate training that have demonstrated minimum entry level competency by being credentialed by a nationally recognized credentialing organization in ultrasound technology (e.g., American Registry of Radiologic Technologists (ARRT) in sonography), (2) performed by or under the direct supervision of a physician, or (3) performed in facilities with laboratories accredited in ultrasonography.