Medical Student Campbell University School of Osteopathic Medicine Cary, North Carolina, United States
Introduction: Neurosurgical resection of brain tumors requires the use of preoperative imaging techniques to safely resect malignancies, especially those near eloquent structures. Diffuse tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) are commonly used for pre-operative planning for tumor resection. DTI allows neurosurgeons to examine the white matter tracts and fMRI allows for indirect measurement of neuronal activity. This study seeks to examine temporal trends in medicare billing and services for these procedures.
Methods: Publicly available Medicare Part B National Summary Data Files were collected from the Medicare and Medicaid website. HCPCS code 70551 was used for DTI and 70554/70555 were used for brain fMRI. Statistical analysis was performed using IBM SPSS Statistics with significance indicated by p< 0.05. Charges adjusted for inflation were calculated using CPI index.
Results: From 2008-2020, the total allowed services for fMRI and DTI were 890 and 2,353,607, respectively. Analysis of temporal trends from 2013-2022 revealed a 71.76% significant decrease in mean Medicare reimbursement for both fMRI and 40.57% DTI (p < 0.001). The annual services per year for both fMRI and DTI fluctuated irregularly from 2013-2020 (R2fMRI = 0.97; R2DTI = -0.88) while the the payment per imaging declined regularly for both fMRI (R2fMRI = 0.817, p <.001) and DTI (R2DTI = 0.860, p <.001). Finally, examination of the adjusted Medicare reimbursement from 2013-2020 revealed an insignificant fluctuation for fMRI (p = 0.140) and a significant regular decrease for DTI (p < 0.001).
Conclusion : Results indicate a decrease in both fMRI and DTI services, with a significant decrease for DTI’s mean reimbursement. The greater decrease in DTI reimbursement relative to fMRI may indicate a possible decline in DTI’s clinical applicability, explained by fMRI’s ability to provide neurosurgeons the same information with an additional functional aspect as well.
