New Study Exposes Potential Expansion Barriers to Functional MRI for Medicare Patients

Reston, VA – A new Harvey L. Neiman Health Policy Institute study found that functional magnetic resonance imaging (fMRI) steadily increased from 2007-2014 but has now been static due to potential expansion barriers. This diagnostic imaging method is critical in determining brain functions as well as for assessing the potential risks of surgery or other invasive treatments of the brain. This American Journal of Neuroradiology (AJNR) study is the first of its kind to assess the nationwide adoption of fMRI.

“Given the relatively new use of fMRI in clinical practice and the possibility that the high costs of fMRI might not be adequately reimbursed by current payer schemes,” said first author Solmaz Asnafi, MD, “we aimed to investigate the use patterns of fMRI with regard to both specialty groups and places of service since the introduction of three unique CPT codes in 2007. The utilization trends we report could inform clinical practice guidelines and payer coverage decisions for fMRI”

Dr. Asnafi and team used the Medicare Physician-Supplier Procedure Summary Master File to evaluate the evolving use of fMRI in Medicare fee-for-service beneficiaries from 2007 through 2017. The researchers found an increased adoption in the first 7 years after unique CPT codes became available, with a plateau in use thereafter. Radiologists have remained the predominant specialty group to perform these services over the decade and the outpatient setting has remained the most common place of service.

“Potential factors that have led to the slowing of fMRI utilization include a 26% decrease in Medicare reimbursement from 2007 to 2017,” stated Jason Allen, MD, PhD, Neuroradiology Division Director and associate radiology professor at Emory University School of Medicine. “In addition, competing technologies for pre-surgical evaluation of refractory focal epilepsy and functional brain mapping might also contribute to blunting the curve of fMRI use in recent years.”

In the United States, the prevalence and incidence of primary brain tumors are on the rise due to a combination of an aging population and improved diagnosis and therapies. Thus, the rate of brain surgery for these tumors will increase as well, particularly because the extent of tumor resection is associated with improved patient outcomes, and the need for preoperative fMRI should increase. Future comparisons of alternative technologies with fMRI trends are warranted to ensure use among Medicare beneficiaries is meeting the population-level clinical needs.