David C. Levin MD, Presenter: Consultant, HealthHelp Board of Directors, Outpatient Imaging Affiliates, LLC

Vijay Madan Rao MD, Abstract Co-Author: Nothing to Disclose

Laurence Parker PhD, Abstract Co-Author: Nothing to Disclose

Jonathan H. Sunshine PhD, Abstract Co-Author: Nothing to Disclose

To determine what percent of all Medicare payments for noninvasive diagnostic imaging (NDI) is attributable to cardiovascular imaging (CVI); and to compare payments to radiologists and cardiologists for the various types of CVI.

Nationwide Medicare Part B fee-for-service data were used. The database provides, among other things, information about payments for each CPT code. All codes related to noninvasive imaging of the heart and non-cerebral vessels were grouped into 8 categories: cardiac CT, cardiac MR, echocardiography, vascular ultrasound (US), vascular CT, vascular MR, cardiac nuclear, and cardiac PET. Medicare physician specialty codes were used to identify radiologists (rads) and cardiologists (cards). Total Part B NDI payments and those for CVI were tabulated. Payment trends from 2000-2009 were examined. All places-of-service were included.

In 2009, total NDI payments to all physicians were $10.075 billion (B), of which $3.581B (36%) was for CVI. Of the CVI payments, cards received $2.352 B (66%) and rads received $407 million (M) (11%). Comparative payments within the 8 categories were: (1) cardiac CT – cards $23.6M, rads $7.6M. (2) cardiac MR – cards $1.7M, rads $1.2M. (3) echo – cards $1.025B, rads $9.8M. (4) vascular US – cards $205.6M, rads $158.8M. (5) vascular CT – cards $17.1M, rads $117.3M. (6) vascular MR – cards $0.9M, rads $18.3M. (7) cardiac nuclear – cards $1.052B, rads $91.5M. (8) cardiac PET – cards $26.0M, rads $2.9M. Between 2000 and 2006, both specialties saw rapid growth in their CVI payments; compound annual growth rates (CAGRs) were 14.6% for cards and 13.4% for rads. However, from 2007-2009 payments declined; the CAGR for cards was -7.4% and that for rads was -4.4%.

Payments for CVI make up 36% of all Medicare Part B payments for NDI. Cards receive considerably more payment than rads; however, the discrepancy is exaggerated because most payments to cards are global, while those to rads are professional-component-only. The only categories where rads received more were vascular CT and vascular MR. Payments to both specialties increased sharply till 2006, but declined thereafter.

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Levin, D, Rao, V, Parker, L, Sunshine, J, Trends in Payments to Radiologists and Cardiologists for Noninvasive Cardiovascular Imaging: Nationwide Medicare Data.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11004012.html