IntroductionIncreasing life expectancy has caused growing concern about maintaining viable neurointerventional practices due to altered Medicare payment structures. This study analyzes the financial trends of three common diagnostic tests for cerebrovascular disease: cerebral digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA).MethodsMedicare Part B National Summary Data files from 2013 to 2020 were queried by Current Procedural Terminology (CPT) codes for DSA (36221–36228), CTA (70496, 70498), and MRA (70544–70547, 70549). Inflation-adjusted charges and reimbursement were calculated using the U.S. City Average Consumer Price Index for Medical Services. Regression analysis was performed on charges, reimbursement, and volume.ResultsA total of 1,519,245 diagnostic procedures were conducted between 2013 and 2020 (782,370 angiograms, 246,603 CTAs, and 490,272 MRAs). A total of $41.005 million was reimbursed by Medicare in 2020 for these diagnostic procedures. The annual percent change in volume for all procedures was −2.90%. From 2013 to 2020, inflation-adjusted: Medicare total physician reimbursement decreased for cerebral angiograms (−4.12%, p = 0.007), CTAs (−2.77%, p = 0.458), and MRAs (−9.06%, p < 0.001). Procedural volume billed to Medicare decreased for cerebral angiograms (−4.63%, p = 0.007) and MRAs (−2.94%, p = 0.0.81) and increased for CTAs (+3.15%, p = 0.004). The greatest increase in Medicare reimbursement (+66.75%) came from CPT code 36224, “place catheter carotid artery”, and the greatest decrease in Medicare reimbursement (−8.66%) came from CPT code 36226, “place catheter vertebral artery.”ConclusionsThis study provides an analysis of Medicare reimbursement trends for routine cerebrovascular angiogram techniques. The findings highlight a decline in Medicare reimbursements for neurointerventionalists.

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诊断性脑血管造影的利用和报销：2013年至2020年医疗保险趋势分析

简介由于医疗保险支付结构的改变，预期寿命的延长引起了人们对维持可行的神经介入治疗的日益关注。本研究分析了脑血管疾病三种常见诊断测试的财务趋势：脑数字减影血管造影（DSA）、计算机断层扫描血管造影（CTA）和磁共振血管造影（MRA）。方法医疗保险B部分2013年至2020年国家摘要数据文件通过 DSA (36221–36228)、CTA (70496、70498) 和 MRA (70544–70547、70549) 的当前程序术语 (CPT) 代码进行查询。通货膨胀调整后的费用和报销是使用美国城市医疗服务平均消费者价格指数计算的。对费用、报销和数量进行回归分析。 结果 2013 年至 2020 年间总共进行了 1,519,245 次诊断程序（782,370 次血管造影、246,603 次 CTA 和 490,272 次 MRA）。2020 年 Medicare 总共为这些诊断程序报销了 4100.5 万美元。所有程序的体积年变化百分比为-2.90%。从 2013 年到 2020 年，经通胀调整后：脑血管造影（−4.12%，p = 0.007）、CTA（−2.77%，p = 0.458）和 MRA（−9.06%，p < 0.001）的医疗保险医生报销总额有所下降。脑血管造影（−4.63%，p = 0.007）和 MRA（−2.94%，p = 0.0.81）的医疗保险费用减少，而 CTA 的费用增加（+3.15%，p = 0.004）。医疗保险报销增幅最大 (+66.75%) 来自 CPT 代码 36224，“放置导管颈动脉”，医疗保险报销增幅最大 (-8.66%) 来自 CPT 代码 36226，“放置导管椎动脉”。研究对常规脑血管造影技术的医疗保险报销趋势进行了分析。研究结果凸显了神经介入医生的医疗保险报销下降。