TY - JOUR
T1 - Cardiac CT and coronary CTA
T2 - Early medicare claims analysis of national and regional utilization and coverage
AU - Duszak, Richard
AU - Optican, Robert J.
AU - Brin, Kenneth P.
AU - Woodard, Pamela K.
PY - 2011/8
Y1 - 2011/8
N2 - 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.
AB - 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.
KW - Medicare utilization and coverage
KW - Radiology and radiologists
KW - cardiac CT
KW - cardiac CT angiography
KW - cardiology and cardiologists
KW - socioeconomic trends
UR - http://www.scopus.com/inward/record.url?scp=84928096496&partnerID=8YFLogxK
U2 - 10.1016/j.jacr.2010.12.024
DO - 10.1016/j.jacr.2010.12.024
M3 - Article
C2 - 21807348
AN - SCOPUS:84928096496
SN - 1546-1440
VL - 8
SP - 549
EP - 555
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 8
ER -