Medicare payments for noninvasive medical imaging, including MRI and CT scans, are now higher to non-radiologists than to radiologists, according to a study in the January issue of the Journal of the American College of Radiology.

“Radiologists have always been considered the physicians who ‘control’ noninvasive diagnostic imaging and are primarily responsible for its growth. Yet non-radiologists have become increasingly aggressive in their performance and interpretation of imaging,” said the study’s lead author David C. Levin, MD, professor of radiology at Thomas Jefferson University in Philadelphia.

The researchers used the Medicare Part B files covering all fee-for-service physician payments for 1998 to 2008. They also selected all codes for discretionary noninvasive diagnostic imaging. Procedures mandated by the patient’s clinical condition (e.g., supervision and interpretation codes for interventional procedures, radiation therapy planning) were excluded, as were non-imaging radionuclide tests. Medicare physician specialty codes were used to identify radiologists and non-radiologists.

They included payments in all places of service and compared overall Medicare noninvasive medical imaging payments to radiologists and non-radiologist physicians from 1998 through 2008. Levin and colleagues conducted a separate analysis of noninvasive diagnostic imaging payments to cardiologists, because next to radiologists, they are the highest users of imaging.

In 1998, the authors reported that the overall Part B payments to radiologists for discretionary noninvasive diagnostic imaging were $2.56 billion, compared with $2.02 billion to non-radiologists. In 2008, non-radiologists received $4.81 billion for discretionary noninvasive diagnostic imaging, and radiologists received $4.65 billion.

The growth in fee-for-service payments to non-radiologists for noninvasive diagnostic imaging was considerably more rapid than the growth for radiologists between 1998 and 2006, the authors reported. Then, by the end of 2008, two years after the implementation of the Deficit Reduction Act (DRA), steeper revenue losses had been experienced by radiologists.

Levin and colleagues noted that by 2008, overall Medicare fee-for-service payments for noninvasive diagnostic imaging were 4 percent higher to non-radiologists than they were to radiologists.

“Our data reveal the somewhat surprising finding that non-radiologist physicians are now paid more for noninvasive diagnostic imaging by Medicare than radiologists,” Levin said. “This has come about because of more rapid growth in fee-for-service payments to non-radiologists between 1998 and 2006, followed by steeper losses among radiologists after implementation of the DRA in 2007.

“Because most imaging by non-radiologists is self-referred, whereas radiologists generally do not have the opportunity to self-refer, this should be of interest and concern to policy makers and payors,” the authors concluded.