In the United States, the Centers for Medicare and Medicaid Services (CMS) effectively determines the amount reimbursed for examinations and procedures. Health care reimbursement plays an important role in the operations of diagnostic radiology. Understanding reimbursement mechanisms, particularly in breast imaging, and its trends in context with other radiological examinations can offer insight into the fundamental operations and future of breast imaging.
CMS reimbursement amounts for screening bilateral mammograms and diagnostic bilateral mammograms were acquired by inputting their associated CPT codes into the CMS physician fee schedule database. Technical component reimbursement, professional component reimbursement, and total reimbursement for each exam were recorded for every other year from 2002 to 2022. The same process was additionally applied for 3 other common radiological exam types outside of breast imaging: one-view chest radiograph, computed tomography (CT) of the head without contrast, and CT of the abdomen and pelvis without contrast. The data were recorded, and linear regression analysis was performed using Microsoft Excel.
A total of 11 reimbursement data point sets were acquired from 2002 to 2022. Six data point sets could be acquired for the CT abdomen and pelvis without contrast exam from 2012 to 2022. The correlation coefficients for total reimbursements for screening bilateral mammograms was –1.5, diagnostic bilateral mammogram was 3.1, chest radiograph 1-view was –0.8, CT head without contrast was –25.1, and CT abdomen and pelvis without contrast was –8.3.
In the 20-year study period, radiological examinations in general demonstrated decreasing reimbursement over time. However, mammograms appear to be less affected by this negative trend with screening and diagnostic bilateral mammogram reimbursement, exhibiting relative stability compared with CT examinations of the head as well as abdomen and pelvis. In fact, diagnostic bilateral mammogram reimbursement was the only examination that demonstrated a positive correlation coefficient and an increase in reimbursement over the 20-year period. This stability in reimbursement portends a positive outlook for breast imaging and reinforces the role of this crucial imaging from a public health perspective.
Alexander L. Hsu,1 Cheng-Han Lee,1 Naveen Galla,1 Julian Franko,1 Karanveer Purewal2
1Department of Radiology, Icahn School of Medicine at Mount Sinai (West), New York, NY.
2Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.