ARRS 2022 Abstracts

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E1873. A Decade of Increased Utilization and Declining Reimbursement of CT Angiography and CT Perfusion of the Head in Medicare Beneficiaries
Authors
  1. Nima Ghorashi; The George Washington University School of Medicine and Health Sciences
  2. Andrew Kolarich; Department of Radiology, The Johns Hopkins Hospital
  3. Jeffrey Elsner; The Johns Hopkins School of Medicine
  4. Haris Sair; Department of Radiology, The Johns Hopkins Hospital
  5. Sachin Gujar; Department of Radiology, The Johns Hopkins Hospital
Objective:
This study aimed to evaluate recent trends in national procedural volume of CTA and CT perfusion (CTP) of the head with specific evaluation of emergency department (ED) utilization.

Materials and Methods:
Physician Summary Procedure Files (PSPS) from the Centers for Medicare and Medicaid Services (CMS) were obtained for the years 2010–2019. Total fee-for-service Medicare beneficiaries were obtained from CMS Program Statistic Reports. CTA and CTP procedures were identified using Common Procedural Terminology (CPT) codes. Annual procedural volume was analyzed. Subsequent analysis by procedure location including office, inpatient hospital, outpatient hospital, and emergency rooms was then performed.

Results:
From 2010–2019, the total number of Medicare fee-for-service beneficiaries ranged from 36.0 million to 38.7 million persons. After adjustment for Medicare enrollment, these values represent an increase in CTA utilization from 383.9 to 1428.1 (+272%) and CTP utilization from 28.0 to 156.3 (+457%) per 100,000 persons per year. Proportional utilization in the ED increased for both CTA (13.9% to 43.4%, p < 0.001) and CTP (30.8 to 49.4%, p < 0.001). Notably, the percentage of CTP reimbursement dropped approximately 100% between 2011 and 2013. There was also a decrease in reimbursement for CTA between 2010 and 2019, which fell from 21.7% to 17.6% (-21.0%).

Conclusion:
Our analysis captured over 36 million Medicare beneficiaries and revealed that on a per capita basis, use of both head CTA and cerebral CTP studies increased several-fold over the last decade. Likewise, during this study period, we found a statistically significant increase in the procedural volume of both CTA head and CTP performed in the ED. With the advent of Medicare’s episode-based bundled payments beginning in 2013, there was near complete decline in CTP reimbursement, with the greatest drop occurring between 2011 and 2013 of approximately 20% decrease in payment for the bundled procedure of CTA head.