Charting Trends in Medicare Reimbursement for Lower Extremity Imaging

Area of Science:

• Radiology and Medical Imaging
• Health Economics
• Healthcare Policy

Background:

• Medicare reimbursement rates are experiencing a notable decline across various medical specialties.
• An in-depth analysis of Medicare reimbursement for common diagnostic imaging procedures in the U.S. is essential.

Purpose of the Study:

• To evaluate Medicare reimbursement trends for the 20 most common lower extremity imaging procedures from 2005 to 2020.
• To assess changes in reimbursement for radiographs, computed tomography (CT), and magnetic resonance imaging (MRI).
• To test the hypothesis that Medicare reimbursement for these imaging procedures has substantially declined.

Main Methods:

• A cohort study analyzing the Centers for Medicare and Medicaid Services Physician Fee Schedule Look-up Tool.
• Reimbursement rates and relative value units for the top 20 lower extremity imaging CPT codes (2005-2020) were examined.
• Inflation-adjusted reimbursement data (2020 USD) was used to calculate annual percentage changes and compound annual growth rates.

Main Results:

• Mean inflation-adjusted reimbursement for all procedures decreased by 32.41% (P = .013).
• The technical component saw the most significant decrease (-85.78%), with MRI and CT experiencing substantial declines.
• CPT code 73720 (MRI lower extremity) showed the largest adjusted decrease at 69.89%.

Conclusions:

• Medicare reimbursement for common lower extremity imaging studies decreased by 32.41% from 2005 to 2020.
• The technical component of reimbursement experienced the most significant reductions, impacting MRI and CT modalities most severely.
• Radiography reimbursement also declined, though to a lesser extent than MRI and CT.