Radiology the only category to see year-over-year decrease in insurers’ max allowed amount
Radiology is the only category to see a year-over-year decrease in health insurers’ maximum “allowed amount” for healthcare services, according to new research published Tuesday.
Transparency firm Fair Health recently analyzed data around this key figure—which represents the highest amount a plan will pay for a covered service. In the year leading up to November 2023, both hospital and professional evaluation and management services saw an allowed amount increase of 3%. The pathology and laboratory allowed amount indices, meanwhile, grew 2% and medicine and surgery recorded a 1% uptick. Radiology, however, was the only category to record a drop, at 4%.
New York-based Fair Health produced the report using its database representing “billions” of privately insured healthcare claims—the largest of its kind in the country.
“Because of its importance to the U.S. economy and the lives of Americans, understanding the trends and shifts in the healthcare sector is vital,” the report concluded. “…Fair Health seeks to provide insights that can inform decision-making by stakeholders throughout the healthcare sector, including consumers, payers, providers, government officials, policymakers and others.”
During the same one-year period, Fair Health also tracked changes in healthcare organizations’ “charge amount.” Both professional evaluation and management and medicine each recorded year-over-year increases of 5%—the largest uptick across the six categories. The pathology and laboratory charge amount index climbed 4%, and surgery increased 3%. Radiology and hospital E/M each increased 1%, which was the smallest change across all categories.
Fair Health also tracked usage of different services across various healthcare settings. At urgent care centers, “diagnostic radiology procedures of the lower extremities” was the only imaging-related item on the list, representing about 1% of claims in 2022. However, in the ED, “diagnostic radiology chest” was the No. 1 claim item, accounting for about 12% of the total (down from 15% in 2021). Diagnostic imaging of the head and neck (6%), abdomen (6%), lower extremities (4%), upper extremities (3%) and spine/pelvis (3%) also made the list.
Finally, Fair Health’s white paper offers a radiology charge amount index, tracking back to May 2012. It covers CPT codes 70010 to 79999, representing a variety of imaging techniques including X-ray, ultrasound, PET, CT and nuclear medicine. Both technical and professional components are incorporated, but not facility fees. The radiology charge amount index saw a slight increase, up to 1.11 in November 2023 (for the aforementioned change of 1%), after remaining flat since May 2021.
You can read the full report here, along with a shorter summary. Fair Health declined to answer questions about the report on Tuesday. The company also released a report in February, which found that average in-network and OON payment amounts in radiology are converging, with the No Surprises Act one likely reason.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.