Barfuss Spencer, Ballard Corinne, Marullo Bethany, Zimmerli Jake, Linscott Luke, Coonradt Cody, Han B Kelly
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, United States; Intermountain Healthcare - Primary Children's Hospital, United States.
Intermountain Healthcare - Primary Children's Hospital, United States.
J Cardiovasc Comput Tomogr. 2025 Jan-Feb;19(1):97-102. doi: 10.1016/j.jcct.2024.12.089. Epub 2025 Jan 22.
Cardiac Computed Tomography (CCT) is increasingly used to provide 2D, 3D and 4D information in patients with congenital heart disease of all ages. Historically, negotiated rates for professional and technical fees associated with cardiac imaging were confidential, with variability in professional, technical and global charges, reimbursement and cost to patients for the same current procedural terminology (CPT) code at different institutions. Billing transparency is a key component of both the CARE act passed in 2020 and the Health Care PRICE Transparency Act 2.0 passed in 2021. Institutional technical fees and negotiated insurance rates by CPT billing code are now publicly available and can be compared between institutions.
A cohort of congenital heart disease programs was identified as the top 50 programs by procedural volume (Society of Thoracic Surgeons database) and by national rankings (US News and World Report). The publicly available negotiated reimbursement rates for the technical component of billing for CPT codes used for CHD CCT (75572, 75573, and 75574) at each center was determined (trybilly.app). The cash price, average insured price and the range of negotiated insured prices for the technical component of CHD CCT were recorded. The variability of technical fee charges for programs were calculated as median, IQR and range. Technical fee correlation to RVUs was also calculated. Professional fee and global procedural fees are not available for comparison.
For the 75572 code, the median charge was $1209.50, IQR (783.50, 1673.75), and range was (49,2618). For the 75573 code, the median charge was $958, IQR (718,1403), and range (60,2622). For the 75574 code the median charge was $1060, IQR (833.5,1604), and range (61,2948). There was a 53-fold difference in technical fee charges for C CT between low and high negotiated insurance prices. Charges for CCT in CHD were not correlated with US News rankings or surgical center volume. There was no correlation between RVUs and technical fees.
There is significant variability in the charges for the technical component of CCT in CHD, not correlated with national ranking or surgical volume. Variability in charges for identical services across centers may have a disproportionate impact on uninsured and underinsured populations. and lead to inequity. This data may inform negotiations for reimbursement for this time-consuming skill set. The variability of technical fee associated with CT for CHD has not been previously analyzed or compared by national ranking or surgical volumes.
心脏计算机断层扫描（CCT）越来越多地用于为各年龄段先天性心脏病患者提供二维、三维和四维信息。从历史上看，与心脏成像相关的专业和技术费用的协商费率是保密的，不同机构对于相同的当前程序编码（CPT），在专业、技术和总费用、报销以及患者成本方面存在差异。计费透明度是2020年通过的《关爱法案》和2021年通过的《医疗保健价格透明度法案2.0》的关键组成部分。现在，机构技术费用和按CPT计费代码协商的保险费率已公开可用，并且可以在不同机构之间进行比较。
通过手术量（胸外科医师协会数据库）和全国排名（《美国新闻与世界报道》）确定了一组先天性心脏病项目，为排名前50的项目。确定了每个中心用于先天性心脏病CCT（75572、75573和75574）的CPT代码计费技术部分的公开协商报销率（trybilly.app）。记录了先天性心脏病CCT技术部分的现金价格、平均保险价格和协商保险价格范围。计算了各项目技术费用的变异性，以中位数、四分位间距和范围表示。还计算了技术费用与相对价值单位（RVUs）的相关性。专业费用和总程序费用无法进行比较。
对于75572代码，中位数费用为1209.50美元，四分位间距（783.50，1673.75），范围为（49，2618）。对于75573代码，中位数费用为958美元，四分位间距（718，1403），范围为（60，2622）。对于75574代码，中位数费用为1060美元，四分位间距（833.5,1604），范围为（61，2948）。低协商保险价格和高协商保险价格之间，CCT技术费用相差53倍。先天性心脏病CCT的费用与《美国新闻与世界报道》排名或手术中心手术量无关。RVUs与技术费用之间没有相关性。
先天性心脏病CCT技术部分的费用存在显著差异，与全国排名或手术量无关。各中心相同服务费用的差异可能对未参保和参保不足人群产生不成比例的影响，并导致不公平。这些数据可为这种耗时技能的报销谈判提供参考。此前尚未按全国排名或手术量对与先天性心脏病CT相关的技术费用变异性进行分析或比较。
