Performance Improvement 2009. Have Advanced Imaging Service Payments Increased Under Medicare's Physician Fee Schedule?


This study documented the nature and extent of growth in advanced imaging-computed tomography, magnetic resonance, and positron emission tomography between 1995 and 2005. Advanced imaging used to be the exclusive domain of hospitals; however, in the last 10 to 15 years, use of these services under the Medicare program has proliferated in ambulatory settings. Oversight of these settings includes accreditation and certification for hospital outpatient departments, State licensure for independent diagnostic testing facilities, and doctors’ offices. In December 2006, final regulations were issued with new performance standards.

Advanced imaging paid under the Medicare Physician Fee Schedule grew significantly between 1995 and 2005: (1) Services per year grew more than fourfold, from 1.4 million to 6.2 million; (2) allowed charges grew by more than 5 times, to $3.5 billion in 2005; and (3) the use rate grew from 42 services per 1,000 beneficiaries in 1995 to 163 per 1,000 in 2005. In 2005, significant variation remained in use rates across States, from 8 services per 1,000 beneficiaries in Vermont to 326 per 1,000 in Florida. In every year from 1995 to 2005, a small number of procedure codes consistently accounted for over half of all advanced imaging billed. The share of all advanced imaging services grew from 2.5 percent in 1995 to 23 percent in 2005.

Report Title: Growth in Advanced Imaging Paid Under the Medicare Physician Fee Schedule
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact: Erin Lemire, 202-205-9523
Performer: Staff; Office of Inspector General

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"PerformanceImprovement2009.pdf" (pdf, 1.26Mb)

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