Paths to Practice Perfection
Making New Waves in Musculoskeletal Ultrasound

In the last decade, there has been an increasing trend towards utilization of diagnostic ultrasound in healthcare. Historically, the most common ultrasound exams were reserved for obstetric, abdominal, pelvic, renal, and frontline-emergent purposes. Musculoskeletal ultrasound has evolved into an important method for identifying musculoskeletal abnormalities, confirming diagnosis, monitoring therapeutic response, influencing clinical decision-making as well as performing guided interventions. Beyond its clinical value, ultrasonography can have a significant impact on the potential growth of a private practice.

Traditional Diagnostic Ultrasound in Podiatry

A standard ultrasound probe uses piezoelectric crystal transducers to create the image. The price may vary from $15,000-$20,000, which does not include the different probes that are needed to obtain images at different depths in the human body. Fortunately, as foot and ankle surgeons, we do not need the amount of depth it takes to visualize deep into the abdomen. Still, the cost of any standard ultrasound machine is a hefty investment. Much of the cost that goes into such a pricey imaging modality is due to the ultrasound transducers.

The standard ultrasound machine is very expensive, large, and clunky, which makes it hard to transport, and requires that there be a nearby outlet as a reliable source of power to operate.

I recently stumbled upon a new portable diagnostic ultrasound technology by Butterfly Network, Inc. This unique handheld device is the only probe with the 3-in-1 (linear, curvilinear, and phased array) in a single probe.

Butterfly iQ+

Unlike standard ultrasounds, this technology produces sound waves by using a silicon chip composed of 9,000 elemental sound sources which replace the more expensive piezoelectric crystals. The user controls the devices through a mobile app, downloadable from the Google or App Store, and is compatible with certain iOS and Android devices (full list here). It comes with a wireless charging station and lasts 8-10 hours between charges. You can read all about set up as well as features here.

Efficient Clinical Decisions at Point-of-Care

Does It Make Economic Sense for Your Practice?

Regarding price, like any piece of equipment in your office, Butterfly is an investment. The second-generation Butterfly iQ+ ultrasound device costs around $2,399, which compared to standard ultrasound as well as other portable ultrasound machines, is much more affordable. The only other requirement is an annual membership, starting at $420 for Cloud storage, together with advanced features and continued app updates throughout the year.

For more information about pricing, click here.

Oftentimes, the rate limiting steps to using diagnostic ultrasound in the private practice setting are two-fold: experience and price.

For experience, there are many conferences that offer ultrasound workshops where you can gain experience to carry into your private practice. I have also put together an online video ultrasound series, all of which you can find here.

A Very Good Investment – for Patient Care and Your Bottom Line1

Let’s look at the investment over the span of 10 years. The cost to invest in Butterfly iQ+ is around $2,399 initially, with an annual fee starting at $420 for Butterfly Cloud membership . So, over the span of 10 years, the amount invested is $6,599.

Before I go into the potential return on investment calculations, I wanted to briefly discuss the CPT codes available to use for musculoskeletal ultrasound, as well as the average reimbursement according to Medicare Physician Fee Schedules (MPFS) by Noridian Healthcare Solutions in 2018. For the sake of a consistent reference point, I will use the Los Angeles County in Southern California to pull average reimbursements which you can find here.

Every practitioner’s practice differs in the number of patients that they see, the number of ‘ultrasound-able’ pathologies that present, and insurance contracts. For the sake of highlighting a point, let’s say that a particular practitioner is seeing 5 patients per week that may require ultrasound. This can be for several different pathologies, but just to name a few: plantar fasciitis, ligamental lisfranc injury, plantar plate injury, neuroma, Achilles’ tendon pathology, and the list goes on.

Longitudinal view of the plantar fascia insertion into the calcaneus.

Five Patient Examples

  1. Plantar fasciitis: Ultrasound guided injection, intermediate – 20606
  2. Achilles’ tendinopathy: Limited anatomic specific ultrasound – 76882
  3. Neuroma: Ultrasound guided injection, small – 20604
  4. Plantar plate injury: Limited anatomic specific ultrasound –76882
  5. Soft tissue mass: Limited anatomic specific ultrasound – 76882

Based on the average 2018 reimbursements, for these 5 patients, the reimbursement would be $371.87. That is in addition to your E&M codes. So, imagine that this was the average reimbursement for a practitioner per week with the addition of ultrasound that translates to an increase in average reimbursements of $19,337.24 per year.

Going back to the 10-year investment for a Butterfly iQ+ of $6,599, compare that to the 10-year potential increase in reimbursement of $193,372.40, that is a 2,830% return on investment! Keep in mind these figures are produced from 5 billable encounters per week. This may be more or less depending on the physician’s workload.


Ultrasound is becoming more and more commonly utilized in medicine in support of point of care diagnosis and treatment. Traditional ultrasonography has mostly been used but not without problems such as clarity, mobility, and high cost. The Butterfly’s portable ultrasound handheld device offers amazing clarity that not only improves support of your clinical diagnosis and treatment, but with just 5 billable encounters per week the return on investment in the private practice setting can be quickly realized.

To learn more about Butterfly iQ+ and how it can benefit your practice visit HERE.

Please Note

  1. Please consult your legal or claims professional for reimbursement advice. Treatment decisions should be made clinically, and not based on monetary reimbursement
  2. The pricing stated is based on the time this was published. Please check the company website for current pricing here.

The statements in this publication are solely those of the Author and not Butterfly Network, Inc 

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