National medicare trends in the utilization of fMRI

• Published in: Neuroscience informatics Vol. 2; no. 1; p. 100031
• Main Authors: Karambelkar, Ajit, Gandhi, Ankit, Trunz, Lukas, Talekar, Kiran, Faro, Scott, Gorniak, Richard, Flanders, Adam E.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.03.2022; Elsevier
• Subjects: RVU; PC; PE; ECoG; TC
• ISSN: 2772-5286; 2772-5286
• DOI: 10.1016/j.neuri.2021.100031

•fMRI utilization for Medicare population tremendously increased from 2007 to 2018 after the introduction of CPT codes.•fMRI is becoming standard of care for the presurgical assessment of brain tumors.•Radiologists contribute most to the fMRI services. We aim to assess the functional magnetic resonance (fMRI) utilization trends among the Medicare population from 2007-2018. Medicare Part B Physician/Supplier Procedure Summary master files from 2010-2018 and Part B National Summary Data Files from 2007-2018 were analyzed for all Current Procedural Terminology, version 4 (CPT-4) codes related to fMRI (70554, 70555, and 96020). The files provided total procedure volume and Medicare payments. Medicare specialty codes were used to determine provider specialty. Medicare place-of-service codes were used to identify locations where services were provided. The total utilization rate and payment of functional neuroradiology services within the Medicare population increased by 192% and 216% from 2007 to 2018, respectively. Volume, utilization, and payments peaked in 2014, with a 278% utilization rate increase since 2007. This peak is mainly attributable to neurologists holding a significant growth and the majority share of CPT code 96020 claims (neuro-functional testing selection and administration during noninvasive imaging) during 2013-2014. Neurologists' share was 61% in 2014, under 96020 claims. In 2018, radiologists and psychologists (59% and 40% respectively) most contributed to the 96020 claims, and neurologists' share bottomed at 1%. Radiologists consistently hold more than a 90% share of CPT code 70554/70555 claims (functional brain MRI without/with physician or psychologist administration) for the past decade. There has been a steady rise of services at inpatient fMRI. The utilization of fMRI has increased mainly due to introducing the CPT codes, and radiologists are the largest provider specialty.