David C Levin1, Vijay M Rao, Laurence Parker. 1. 1 Department of Radiology, Center for Research on Utilization of Imaging Services, Thomas Jefferson University Hospital, 132 S 10th St, Main 1090, Philadelphia, PA 19107.
Abstract
OBJECTIVE: On January 1, 2011, the Current Procedural Terminology version 4 codes for CT of the abdomen and CT of the pelvis were bundled together. The relative value units attached to the new single codes were lower than the sum of the relative value units accruing to the two separate codes. The purpose of this study was to assess the effect of this new policy on Medicare part B reimbursements for these studies. MATERIALS AND METHODS: The nationwide 2001-2011 Medicare part B data files were used to select the codes for CT of the abdomen and pelvis before and after bundling occurred in 2011. Procedure volumes were ascertained, and utilization rates per 1000 Medicare beneficiaries were calculated. Aggregate Medicare reimbursements were determined, and Medicare specialty codes were used to determine the reimbursements to radiologists. RESULTS: In 2011, use of CT of the two body regions remained approximately the same as in 2010 (before bundling), but because the two codes were bundled into one in 2011, the actual rate per 1000 decreased from 277.1 to 148.1. Medicare reimbursements for CT of the abdomen and pelvis had risen steadily from 2001 to 2005 but remained relatively stable thereafter through 2010. However, in 2011 reimbursements decreased from $971.5 million the previous year to $687.0 million--a drop of $284.5 million (29%) in a single year. Radiologists experienced $218.6 million of this decrease. CONCLUSION: Code bundling of CT of the abdomen and CT of the pelvis resulted in a large reduction in reimbursements for imaging.
OBJECTIVE: On January 1, 2011, the Current Procedural Terminology version 4 codes for CT of the abdomen and CT of the pelvis were bundled together. The relative value units attached to the new single codes were lower than the sum of the relative value units accruing to the two separate codes. The purpose of this study was to assess the effect of this new policy on Medicare part B reimbursements for these studies. MATERIALS AND METHODS: The nationwide 2001-2011 Medicare part B data files were used to select the codes for CT of the abdomen and pelvis before and after bundling occurred in 2011. Procedure volumes were ascertained, and utilization rates per 1000 Medicare beneficiaries were calculated. Aggregate Medicare reimbursements were determined, and Medicare specialty codes were used to determine the reimbursements to radiologists. RESULTS: In 2011, use of CT of the two body regions remained approximately the same as in 2010 (before bundling), but because the two codes were bundled into one in 2011, the actual rate per 1000 decreased from 277.1 to 148.1. Medicare reimbursements for CT of the abdomen and pelvis had risen steadily from 2001 to 2005 but remained relatively stable thereafter through 2010. However, in 2011 reimbursements decreased from $971.5 million the previous year to $687.0 million--a drop of $284.5 million (29%) in a single year. Radiologists experienced $218.6 million of this decrease. CONCLUSION: Code bundling of CT of the abdomen and CT of the pelvis resulted in a large reduction in reimbursements for imaging.
Authors: Arthur S Hong; David Levin; Laurence Parker; Vijay M Rao; Dennis Ross-Degnan; J Frank Wharam Journal: Radiology Date: 2019-12-31 Impact factor: 29.146