Back Imaging by Place of Service

Introduction:

When it comes to back imaging there are many options to choose from. A great question to ask, is if an MRI or CT scan is needed or will a simple X-ray do? If it is decided that a more complicated MRI or CT scan is needed, will the procedure be done with or without dye? Then, there is a question of where the imaging will be done. Can your primary care doctor or local clinic do the imaging? Or does it need to be done at an outpatient hospital setting? Many of these questions are best answered by speaking with a healthcare provider. In this report, we highlight some important differences in cost and price, based on the type of imaging needed and the place of service.

Results: 

The 2018 median clinic cost for each type of imaging procedures was lower than the same service performed at an outpatient hospital setting. In some cases, the average savings was hundreds of dollars. Also, it is worth noting that with the exception of CT scans, the price variation at an outpatient hospital setting was much larger. The graph below shows the interquartile range (IQR) of the cost of back imaging procedures by place of service. This range spans from the 25th to 75th percentiles. It should also be noted that MRI and CT scans in a clinical setting were skewed towards higher costs, while X-ray costs were not, and the CT scans at outpatient hospitals were slightly skewed towards lower costs. For example, the typical cost of a MRI in a clinic ranged from $220 to about $538, while in an outpatient hospital, the costs ranged from about $174 to approximately $1,350. This shows that costs for MRIs vary more in outpatient hospitals than at clinics.

Roughly two-thirds of X-rays were performed in a clinic. The number of MRIs performed were split almost evenly between clinics and hospitals. For the CT scans two-thirds of them were performed at an outpatient hospital setting. 

Methods:

Back imaging procedures were determined by CPT4 codes. For most imaging procedures there is a technical and a professional component to the services. These components can be identified by the CPT4 modifier codes. Due to differences in billing practices, it is not always clear when the components are billed together or separately. Usually, the technical component accounts for most of the cost, and many locations only bill the technical component. For this reason, we excluded procedures that were only marked as the professional component from our analysis.

We also determined although there was some cost variation within a procedure category (e.g. X-rays) related to the imaging procedure code, there was much more variation between procedure category and place of service. For this reason, all X-rays, MRIs, and CT scan procedures were grouped into their individual category. Specific CPT4 codes included are:

X-rays: 72020, 72070, 72072, 72074, 72080, 72081, 72082, 72083, 72084, 72100, 72110, 72114, 72120, 72295
MRIs: 72148, 72149, 72158
CT Scan: 72131, 72132, 72133

Only commercial insurance claims that were marked as primary paid were used. Outliers and procedures that were bundled and had no cost assigned to them were also removed. Place of service was determined by using the Milliman HCG settings and claim place of service codes. Due to bundling nature of inpatient hospital claims and inability for patients to shop around, inpatient claims and unknown or indeterminable place of service claims were also excluded from the analysis.

Conclusion:

Place of service matters when it comes to cost while the quality of the procedure is not impacted. There are also notable differences in costs of different imaging services. Knowing your options may end up saving you hundreds of dollars. Consider discussing your imaging options with your healthcare provider in order to make an informed decision about price and service.