LeBaron Zachary G, Richman Evan H, Brown Parker J, Minzer Ian D, Brinkman Joseph C, Hinckley Nathaniel, Fox Michael G, Patel Karan
School of Medicine, Creighton University-Phoenix Regional Campus, Phoenix, Arizona, USA. .
Department of Orthopedic Surgery, University of Colorado-Anschutz Campus, Aurora, Colorado, USA.
Orthop J Sports Med. 2023 Mar 21;11(3):23259671221147264. doi: 10.1177/23259671221147264. eCollection 2023 Mar.
Medicare reimbursement is rapidly declining in many specialties. An in-depth analysis of Medicare reimbursement for routinely performed diagnostic imaging procedures in the United States is warranted.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate Medicare reimbursement trends for the 20 most common lower extremity imaging procedures performed between 2005 and 2020, including radiographs, computed tomography (CT), and magnetic resonance imaging (MRI). We hypothesized that Medicare reimbursement for imaging procedures would decline substantially over the studied period.
Cohort study.
The Physician Fee Schedule Look-up Tool from the Centers for Medicare and Medicaid Services was analyzed for reimbursement rates and relative value units associated with the top 20 most utilized Current Procedural Terminology (CPT) codes in lower extremity imaging from 2005 to 2020. Reimbursement rates were adjusted for inflation and listed in 2020 US dollars using the US Consumer Price Index. To compare year-to-year changes, the percentage change per year and compound annual growth rate were calculated. A 2-tailed test was used to compare the unadjusted and adjusted percentage change over the 15-year period.
After adjusting for inflation, mean reimbursement for all procedures decreased by 32.41% ( = .013). The mean adjusted percentage change per year was -2.82%, and the mean compound annual growth rate was -1.03%. Compensation for the professional and technical components for all CPT codes decreased by 33.02% and 85.78%, respectively. Mean compensation for the professional component decreased by 36.46% for radiography, 37.02% for CT, and 24.73% for MRI. Mean compensation for the technical component decreased by 7.76% for radiography, 127.66% for CT, and 207.88% for MRI. Mean total relative value units decreased by 38.7%. The commonly billed imaging procedure CPT 73720 (MRI lower extremity, other than joint, with and without contrast) had the greatest adjusted decrease of 69.89%.
Medicare reimbursement for the most billed lower extremity imaging studies decreased by 32.41% between 2005 and 2020. The greatest decreases were noted in the technical component. Of the modalities, MRI had the largest decrease, followed by CT and then radiography.
医疗保险报销在许多专科领域正迅速下降。有必要对美国常规进行的诊断性成像检查的医疗保险报销情况进行深入分析。
目的/假设：本研究的目的是评估2005年至2020年间20种最常见的下肢成像检查的医疗保险报销趋势，包括X线摄影、计算机断层扫描（CT）和磁共振成像（MRI）。我们假设在所研究的时间段内，成像检查的医疗保险报销会大幅下降。
队列研究。
分析医疗保险和医疗补助服务中心的医师费率表查询工具，以获取2005年至2020年间下肢成像中使用最多的前20个现行程序编码（CPT）相关的报销费率和相对价值单位。报销费率根据通货膨胀进行调整，并使用美国消费者价格指数以2020年美元列出。为了比较逐年变化，计算了每年的百分比变化和复合年增长率。使用双尾检验来比较15年期间未调整和调整后的百分比变化。
在调整通货膨胀后，所有检查的平均报销下降了32.41%（P = 0.013）。每年的平均调整后百分比变化为 -2.82%，平均复合年增长率为 -1.03%。所有CPT编码的专业和技术部分的补偿分别下降了33.02%和85.78%。X线摄影的专业部分平均补偿下降了36.46%，CT为37.02%，MRI为24.73%。X线摄影的技术部分平均补偿下降了7.76%，CT为127.66%，MRI为207.88%。平均总相对价值单位下降了38.7%。常用的成像检查程序CPT 73720（下肢MRI，关节以外，有或无造影剂）调整后的降幅最大，为69.89%。
2005年至2020年间，医疗保险对报销次数最多的下肢成像检查的报销下降了32.41%。技术部分的降幅最大。在这些检查方式中，MRI的降幅最大，其次是CT，然后是X线摄影。
