Changes in Medicare Reimbursement for Advanced Upper Extremity Imaging.

PURPOSE: Advanced noninvasive imaging of the upper extremity joints, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) , has numerous applications in the evaluation of musculoskeletal pathology. Choice of modality is influenced by clinical and cost concerns, with US and CT traditionally considered less expensive than MRI. We analyzed the changes in Medicare reimbursement for these imaging modalities with the hypothesis that recent reimbursement decreases in MRI have made this modality more cost-competitive than other commonly used imaging modalities.

METHODS: Using the Medicare Fee Schedule Database, we reviewed the Medicare reimbursements fee schedule for CT, US, and MRI from 2000 to 2015 at the national, regional, and state levels. Charges were identified and queried by Common Procedural Terminology (CPT) codes for each modality. Changes in reimbursement were calculated for each of the modalities.

RESULTS: Total (technical and professional) reimbursement for MRI decreased from $516.93 to $237.16 between 2007 and 2015. Adjusted for inflation, this represents a 60% decrease in reimbursement. During the same time period, total (technical and professional) reimbursement for CT decreased from $256.95 to $180.03, a 39% decrease adjusted for inflation. Total (technical and professional) reimbursement for US increased over the same time period, from $98.91 to $118.22 in 2015, in conjunction with changes in the CPT coding for US. Total (technical and professional) MRI reimbursement decreased from 5.23 times the reimbursement of US in 2007 to 2.01 times in 2015.

CONCLUSIONS: In concordance with our hypothesis, these findings demonstrate that upper extremity MRI and CT reimbursements as scheduled by Medicare have declined significantly in recent years and that these modalities are approaching financial parity with wrist US. In spite of these decreases, MRI remains the most costly advanced imaging modality. Depending on each clinical scenario, the added cost may be justified by the value added by the type of information that can be garnered from each study. Cost-analysis studies evaluating the clinical application of MRI performed prior to the reimbursement decline should be evaluated with caution, and cost-benefit analyses based on these data are at risk of being out-of-date.

TYPE OF STUDY/LEVEL OF EVIDENCE: Economic Analysis IV.