Fatty liver has become so common that trainees often see steatosis more frequently than a normal liver. During the latest AJR Forum on Quantitative Ultrasound, David Fetzer, MD, asked Roentgen Fund recipient Theodore Pierce, MD, a practical question regarding liver fat assessment:
Are practices billing for liver fat quantification, and is it performed alone or bundled with other exams?
The Big Picture
Liver fat quantification is increasingly embedded in routine abdominal imaging. But billing practices, reimbursement, and workflow integration vary widely across institutions. Dr. Pierce noted that while they do code and submit billing for fat quantification, reimbursement remains inconsistent at this stage.
Key Takeaways
Billing is performed, even though reimbursement is not yet reliable. Fat quantification is coded whenever performed. Reimbursement is infrequent but expected to improve as adoption grows and payers recognize the clinical value.
Standalone liver fat quantification exists, but it is rarely used. Although offered as its own CPT-coded exam, most clinicians prefer to order it in combination with either a limited right upper quadrant ultrasound or with both RUQ ultrasound and elastography. The combination is determined by the referring clinician and the specific clinical question.
Interpretation requires clinical and imaging context. As Dr. Fetzer emphasized, fat quantification values are interpreted alongside B-mode appearance and elastography stiffness to evaluate steatosis, fibrosis, and inflammation. The combined data provide a more accurate assessment than any single technique alone.
Bottom Line
Liver fat quantification is billable, clinically valuable, and most informative when paired with RUQ ultrasound and elastography. Utilization is increasing, reimbursement frameworks are evolving, and the technique is moving toward becoming a routine component of hepatic imaging.
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