Mid-South Imaging and Therapeutics, Memphis, Tennessee 38120, USA.
J Am Coll Radiol. 2011 Apr;8(4):235-41. doi: 10.1016/j.jacr.2010.08.028.
The aim of this study was to assess national and regional trends in utilization and Medicare coverage of diagnostic CT colonography (CTC).
Medicare claims for diagnostic CTC were identified for the first 4 complete years for which Current Procedural Terminology® tracking codes existed (2005-2008). The frequencies of billed and denied services were extracted on a national and regional basis, along with physician provider specialty and site of service.
Total annual claims for diagnostic CTC for Medicare fee-for-service beneficiaries increased from 3,660 to 10,802 (+195%) between 2005 and 2008. Overall, 50.1% (14,051 of 28,048) of all claims were denied, with annual national denial rate decreasing from 70.0% to 43.4% (2,562 of 3,660 to 4,692 of 10,802, P < .001). Annual regional denial rates ranged from 16.5% to 98.3%. Of all 28,048 CTC claims, 25,893 (92.3%) were submitted by radiologists, 286 (1.0%) by gastroenterologists, and 369 (1.3%) by other specialists (specialties were indeterminate for 1,550). Most services were performed in office (n = 13,764 [49.1%]) and outpatient hospital (n = 12,110 [43.2%]) settings, with only a small number in the inpatient hospital (n = 1,768 [6.3%]) and other miscellaneous (n = 406 [1.4%]) settings.
Diagnostic CTC is performed predominantly by radiologists in private office and outpatient hospital settings. Since the advent of Current Procedural Terminology tracking codes, the utilization of diagnostic CTC by Medicare fee-for-service beneficiaries has tripled. Despite perceptions that new technology tracking codes are not payable, more than half of all examinations are now reimbursed by Medicare. Coverage varies regionally but overall is improving annually, setting the stage for expanded patient access.
本研究旨在评估诊断性 CT 结肠成像（CTC）在全国和地区的应用和医疗保险覆盖情况。
在现有的当前程序术语（CPT）跟踪代码的前 4 个完整年内，确定了医疗保险诊断性 CTC 的索赔。按全国和地区的基础提取计费和拒付服务的频率，以及医生提供者的专业和服务地点。
在 2005 年至 2008 年间，医疗保险按服务收费受益人的诊断性 CTC 年度总索赔从 3660 增加到 10802（增加 195%）。总体而言，所有索赔的 50.1%（14051/28048）被拒绝，全国年度拒绝率从 70.0%下降到 43.4%（2562/3660 到 4692/10802，P<.001）。年度区域拒绝率范围为 16.5%至 98.3%。在所有 28048 例 CTC 索赔中，25893 例（92.3%）由放射科医生提交，286 例（1.0%）由胃肠病学家提交，369 例（1.3%）由其他专家提交（1550 例无法确定专业）。大多数服务是在办公室（n=13764[49.1%]）和门诊医院（n=12110[43.2%]）进行的，只有少数在住院医院（n=1768[6.3%]）和其他杂项（n=406[1.4%]）进行。
诊断性 CTC 主要由私人办公室和门诊医院环境中的放射科医生进行。自采用当前程序术语跟踪代码以来，医疗保险按服务收费受益人的诊断性 CTC 使用率增加了两倍。尽管人们认为新的技术跟踪代码不可支付，但现在 Medicare 报销了一半以上的检查。覆盖范围因地区而异，但总体上每年都在改善，为扩大患者准入铺平了道路。
