Passage of the Patient Protection and Affordable Care Act legislation will impact vascular surgery in many ways. As imaging accounts for 23% of Vascular Surgery Medicare Part B revenues, vascular surgeons will be negatively affected by changes in reimbursement schemes and methodologies proposed by various agencies. The Medicare Payment Advisory Commission is an agency charged by Congress for reviewing Medicare payment policies and recommending changes. Although current recommendations are directed toward "advanced" and more costly imaging services, vascular surgeons and the ultrasound community are advised to watch out for any recommendations that may adversely impact patient access and convenience.