Journal of the American College of Radiology : JACR · 2011
Cardiac CT and coronary CTA: early Medicare claims analysis of national and regional utilization and coverage.
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Duszak Richard, Optican Robert J, Brin Kenneth P, Woodard Pamela K
Аннотация
PURPOSE: The aim of this study was to assess trends in utilization and Medicare coverage of cardiac CT and coronary CT angiography (CCTA).
METHODS: Medicare claims for cardiac CT and CCTA were identified for the first 3 complete years for which Current Procedural Terminology(®) tracking codes existed (2006-2008). The frequencies of billed and denied services were extracted on national and regional bases, along with reporting physician specialty and site of service.
RESULTS: Total annual claims for cardiac CT and CCTA services for Medicare fee-for-service beneficiaries increased from 58,124 to 95,269 (+64%) between 2006 and 2008. The overall percentage of denied claims decreased from 34% to 21% (20,014 of 58,124 to 20,062 of 95,269, P < .001), with the highest denial rate for calcium scoring studies (declining from 82% to 61%) and the lowest rate for CCTA (29% to 14%). Annual overall regional denial rates ranged from 8.9% to 80.6%. Of all 254,672 base services, 138,136 claims (54%) were submitted by cardiologists, 90,767 (36%) by radiologists, and 13,445 (5%) by others. In 12,324 cases (5%), provider specialty was undetermined. Two-thirds (67%) of services were reported in the office setting (170,511), followed by the outpatient hospital (64,008 [25%]), inpatient hospital (15,922 [6%]), ER (1,577 [1%]), and all other (2,654 [1%]) settings.
CONCLUSION: Most cardiac CT and CCTA services are reported by cardiologists and most takes place in private office and outpatient hospital settings. During the first 3 years of Current Procedural Terminology tracking codes, the utilization of cardiac CT and CCTA by Medicare fee-for-service beneficiaries increased by 64%. Despite perceptions that new technology tracking codes are rarely payable, a large majority of all examinations are reimbursed by Medicare. Coverage varies regionally but overall has improved, setting the stage for expanded patient access.
METHODS: Medicare claims for cardiac CT and CCTA were identified for the first 3 complete years for which Current Procedural Terminology(®) tracking codes existed (2006-2008). The frequencies of billed and denied services were extracted on national and regional bases, along with reporting physician specialty and site of service.
RESULTS: Total annual claims for cardiac CT and CCTA services for Medicare fee-for-service beneficiaries increased from 58,124 to 95,269 (+64%) between 2006 and 2008. The overall percentage of denied claims decreased from 34% to 21% (20,014 of 58,124 to 20,062 of 95,269, P < .001), with the highest denial rate for calcium scoring studies (declining from 82% to 61%) and the lowest rate for CCTA (29% to 14%). Annual overall regional denial rates ranged from 8.9% to 80.6%. Of all 254,672 base services, 138,136 claims (54%) were submitted by cardiologists, 90,767 (36%) by radiologists, and 13,445 (5%) by others. In 12,324 cases (5%), provider specialty was undetermined. Two-thirds (67%) of services were reported in the office setting (170,511), followed by the outpatient hospital (64,008 [25%]), inpatient hospital (15,922 [6%]), ER (1,577 [1%]), and all other (2,654 [1%]) settings.
CONCLUSION: Most cardiac CT and CCTA services are reported by cardiologists and most takes place in private office and outpatient hospital settings. During the first 3 years of Current Procedural Terminology tracking codes, the utilization of cardiac CT and CCTA by Medicare fee-for-service beneficiaries increased by 64%. Despite perceptions that new technology tracking codes are rarely payable, a large majority of all examinations are reimbursed by Medicare. Coverage varies regionally but overall has improved, setting the stage for expanded patient access.