CMS creates a neuraxial ultrasound code after RIVANNA's push, payment not included

Why it matters

A dedicated code can turn Accuro 3S use into measurable hospital data, helping RIVANNA build the clinical and economic case that CMS payment and wider adoption would require.

The Centers for Medicare & Medicaid Services (CMS) has created an inpatient procedure code for computer-aided ultrasound navigation and continuous needle tracking during neuraxial anesthesia, handing RIVANNA a way to measure use of the clinical category it is working to establish.

Charlottesville-based RIVANNA announced on September 17th that ICD-10-PCS code XEZU3HC will take effect for inpatient discharges beginning October 1st. The code covers a type of procedure rather than RIVANNA or its Accuro 3S product, and it creates no separate payment. Its immediate value is visibility: hospitals will be able to record when clinicians use real-time ultrasound navigation with continuous needle tracking in the spinal canal.

For co-founders Will Mauldin and Kevin Owen, a billing classification is an unusually bureaucratic milestone in a founder story that began with improvised ultrasound hardware. Mauldin identified epidural and spinal anesthesia placement as a target while pursuing a biomedical engineering doctorate at the University of Virginia and taking a course at UVA's Darden School of Business. He recruited Owen, another biomedical engineering graduate student with product-development experience, and the pair assembled early circuit boards in Owen's attic using a toaster oven. A trailer hitch, hot glue and a deer-spine phantom helped complete the first prototype, according to RIVANNA's account of its founding.

That prototype became Accuro, an ultrasound platform designed to identify spinal anatomy before clinicians insert a needle. The newer Accuro 3S carries imaging into the procedure itself, combining automated anatomical analysis, a probe built around a central needle aperture and software that displays the needle tip and trajectory in real time.

A code before cash

CMS placed XEZU3HC in Section X, the ICD-10-PCS area reserved for new technology. The agency's Spring 2026 coding materials described the previous problem plainly: hospitals could record the introduction of an anesthetic agent into the spinal canal, while use of a diagnostic ultrasound navigation system was not separately reported. CMS recommended adding a new table and technology value to identify computer-aided guidance using ultrasound and continuous needle tracking.

The final code gives RIVANNA a standardized data field that can be connected with clinical and operational records. RIVANNA plans to add XEZU3HC, when assigned by participating hospitals, to an outcomes framework beginning in the fourth quarter of 2026.

That work will determine whether the code becomes a commercial lever or merely a cleaner line in hospital data. A specific code can help RIVANNA assemble comparisons across institutions rather than relying on scattered records and individual studies.

RIVANNA says it did not seek a New Technology Add-on Payment for fiscal 2027. In its explanation of the coding strategy, RIVANNA argues that real-world evidence should come first and support later payment discussions. That sequence also delays the harder commercial test: hospitals receive a way to identify the procedure on October 1st, without receiving an additional CMS payment simply for using it.

The technology-neutral language carries another constraint for RIVANNA. XEZU3HC does not reserve the category for Accuro 3S. Any system that meets the procedure description could benefit from the coding infrastructure, giving competitors a data pathway that RIVANNA helped establish.

Accuro 3S still needs its own outcomes record

The Food and Drug Administration cleared Accuro 3S in May 2025 as a diagnostic ultrasound system. Accuro 3S uses SpineNav-AI to identify lumbar landmarks, the spinal midline and estimated epidural depth. RIVANNA's Dual-Array probe places two ultrasound transducer arrays around a central aperture for needle insertion, while SafeTrack shows the location and direction of a compatible tracked needle.

The published clinical evidence cited in RIVANNA's announcement concerns the earlier Accuro platform. In a randomized trial of 80 obese patients undergoing elective cesarean delivery, researchers reported first-insertion success of 72.5% with Accuro versus 40% with palpation. The ultrasound group also had fewer needle redirections, while paresthesia occurred in 7.5% of patients versus 45% in the palpation group. The researchers specified that experienced anesthesiologists performed the procedures.

Those results do not establish the performance of Accuro 3S, which adds real-time needle tracking and uses different hardware. Mauldin acknowledged the evidence gap in RIVANNA's announcement, saying the code "does not prove benefit" and instead gives hospitals a consistent way to identify use and evaluate outcomes.

That distinction keeps the CMS decision in proportion. Coding recognition gives RIVANNA infrastructure for evidence generation, rather than clinical validation or reimbursement. It also lets Mauldin pursue the commercial thesis behind the original attic-built prototype: spinal needle placement should become an image-guided procedure whose performance can be measured, compared and improved.

RIVANNA has reached the point where hospital adoption will provide a clearer verdict than another controlled demonstration. XEZU3HC gives Mauldin and Owen the data trail. Accuro 3S still has to earn what follows from it.