National medicare trends in the utilization of fMRI

Abstract

Purpose: We aim to assess the functional magnetic resonance (fMRI) utilization trends among the Medicare population from 2007-2018. Materials and methods: 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. Results: 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. Conclusion: The utilization of fMRI has increased mainly due to introducing the CPT codes, and radiologists are the largest provider specialty.