Changes in Medicare Reimbursement for Advanced Upper Extremity Imaging.

Area of Science:

• Radiology
• Medical Imaging
• Health Economics

Background:

• Advanced noninvasive imaging modalities like computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) are crucial for evaluating musculoskeletal pathology in upper extremities.
• Historically, ultrasound (US) and CT have been considered more cost-effective than MRI, influencing modality selection based on clinical needs and budget constraints.

Purpose of the Study:

• To analyze changes in Medicare reimbursement rates for CT, MRI, and US of the upper extremity from 2000 to 2015.
• To test the hypothesis that recent decreases in MRI reimbursement have improved its cost-competitiveness relative to CT and US.

Main Methods:

• Utilized the Medicare Fee Schedule Database to review national, regional, and state reimbursement fees for CT, MRI, and US between 2000 and 2015.
• Identified and queried charges using Common Procedural Terminology (CPT) codes for each imaging modality.
• Calculated the changes in reimbursement for each modality, adjusted for inflation.

Main Results:

• Between 2007 and 2015, total Medicare reimbursement for MRI decreased by 60% (adjusted for inflation), falling from $516.93 to $237.16.
• Over the same period, CT reimbursement decreased by 39% (adjusted for inflation), from $256.95 to $180.03.
• In contrast, US reimbursement increased by 20% from $98.91 to $118.22, partly due to CPT coding changes. MRI reimbursement fell from 5.23 times that of US in 2007 to 2.01 times in 2015.

Conclusions:

• Medicare reimbursement for upper extremity MRI and CT has significantly declined, making them more financially comparable to wrist US.
• While MRI remains the most expensive advanced imaging modality, its cost-benefit must be weighed against the diagnostic information it provides.
• Previous cost-analysis studies on MRI should be re-evaluated with caution due to outdated reimbursement data.