Nonradiologists Get Bulk of Medicare Reimbursement for Imaging

Nonradiologists receive more than half of diagnostic radiology fees issued by Medicare, according to a study published in the American Journal of Roentgenology.

Researchers from Virginia, California, and Georgia studied regional variation in the Medicare Physician Fee Schedule (MPFS) payments for medical imaging made to radiologists compared with nonradiologists.

The researchers used a 5% random sample from approximately 2.5 million Part B beneficiaries of Medicare enrollees covered in 2011. Calculations were done of state-by-state spending and regional spending for all Medicare-covered medical imaging services. The researchers also identified payments to radiologists versus nonradiologists.

The results showed that, nationally, mean MPFS medical imaging spending per Medicare beneficiary was $207.17. Radiologists received an average of $95.71 and nonradiologists received an average of $111.46. “Of professional-only (typically interpretation) payments, 20.6 percent went to nonradiologists,” the researchers wrote. “Of technical-only (typically owned equipment) payments, 84.9 percent went to nonradiologists. Of global (both professional and technical) payments, 70.1% went to nonradiologists.”

The percentage of MPFS medical imaging varied geographically, with spending on nonradiologists ranging from 32% in Minnesota to 69.5% in South Carolina. “The percentage of MPFS payments for medical imaging to nonradiologists exceeded those to radiologists in 58.8% of states,” the researchers noted. The relative percentage of MPFS payments to nonradiologists was highest in the South at 58.5%, and lowest in the Northeast, at 48.0%.

In breaking down what areas of imaging were reimbursed, the researchers found that of the $111.46 per beneficiary paid to nonradiologists, most ($46.62) went to cardiology, followed by internal medicine ($9.57), and orthopedic surgery ($7.43).

Specific modalities billed most commonly by radiologists were:

• CT: 73,373,949; 30.4%

• MRI: 65,923,094; 27.3%

• Radiography: 62,181,501; 25.8%

• Ultrasound: 24,025,296; 10.0%

• Nuclear medicine: 11,360,303; 4.7%

Specific modalities billed most commonly by nonradiologists were:

• Ultrasound: 111,589,763; 39.7%

• Nuclear medicine: 62,497,071; 22.2%

• Radiography: 57,123,644; 20.3%

• CT: 16,399,497; 6.51%

• MRI: 14,672,477; 5.2%

The researchers concluded that 53.8% of MPFS payments for medical imaging services are made to nonradiologists, who claim a majority of MPFS payments in most states dominated by noninterpretive payments.