Example of neuroradiology case mix and 2019 Medicare fees compared with private insurance5,6a
| Examination (CPT) | No. of Examinations (2019) | Case Mix (%) | NR | Medicare Global | PI Global | Medicare PC | PI PC | Medicare TC | PI TC |
|---|---|---|---|---|---|---|---|---|---|
| CT head (70450) | 44,300 | 69.5 | $0 | $115.20 | $369.82 | $43.72 | $74.54 | $71.48 | $295.28 |
| CT head with contrast (70460) | 50 | 0.1 | $0 | $162.76 | $420.63 | $58.56 | $95.97 | $104.20 | $324.66 |
| CT head without and with contrast (70470) | 564 | 0.9 | $0 | $190.09 | $437.57 | $65.34 | $106.08 | $124.74 | $331.49 |
| MR imaging brain (70551) | 9400 | 14.7 | $0 | $224.92 | $550.98 | $76.16 | $131.26 | $148.77 | $419.72 |
| MR imaging brain with contrast (70552) | 244 | 0.4 | $0 | $311.96 | $486.19 | $91.71 | $158.49 | $220.24 | $327.70 |
| MR imaging brain without and with contrast (70553) | 9225 | 14.5 | $0 | $368.27 | $911.65 | $117.39 | $217.90 | $250.88 | $693.75 |
| Total | 63,783 | 100.0 |
Note:—NR indicates nonreimbursed; PI, private insurance; TC, technical component; CPT, Current Procedural Terminology.
↵a Medicare fees are based on the Medicare Physician Fee Schedule database with the following criteria: year 2019 and MAC locality 0720201.5 There was no difference between Medicare facility and nonfacility fees. Private insurance fees were obtained from IBM MarketScan Commercial Claims and Encounters Database for the year 2017. Payments were adjusted for inflation using the Consumer Price Index for Medical Care obtained from the Federal Reserve Bank of St. Louis and expressed in 2019 US Ddollars.6