Medicare MRI reimbursement has plummeted 77% since 2003, when adjusting for inflation
Medicare reimbursement for MRI exams has plummeted nearly 77% since 2003 when adjusting for inflation, according to research published Tuesday in Clinical Imaging.
The average decrease was approximately $1,004—with a range of between $590 and $1,630 (or 64%–84%)—from peak reimbursement levels between 2003 and 2025. These findings come as Medicare prepares to implement “efficiency” adjustments to payment rates, cutting reimbursement by 2.5% to account for gains physicians have made due to technological advances.
Magnetic resonance imaging exams are being delivered faster, thanks to abbreviated protocols aided by artificial intelligence. But experts contend Medicare and other insurers should not cut MRI pay just because of efficiencies.
“Large decreases in CMS reimbursement for many imaging modalities [have] occurred over the past two decades, disproportionately affecting MRI, with reimbursement now comparable to alternative modalities,” Andrew Huang, MD, with Michigan Medicine, Ann Arbor, and co-authors wrote Nov. 4. “Reimbursement for ‘focused’ MRI exams that are shorter—yet fully diagnostic and sufficient to answer specific clinical questions—should not be reduced, considering the dramatic decrease in reimbursement that has already occurred in the past two decades.”
For the study, Huang and colleagues used American College of Radiology Appropriateness Criteria to select common imaging exams for analysis. They utilized Centers for Medicare & Medicaid Services fee schedules spanning 20 years to track reimbursement trends over time. Inflation adjustments were performed using correction factors provided by the Bureau of Labor Statistics.
Reimbursement for all imaging exams studies decreased “substantially” between 2003 to 2025. Computed tomography also experienced a large drop in reimbursement, falling about 69% or $466 during the study period. The range across different CT exam types was between 38% and 82% (or $61 to almost $859). Ultrasound, radiography and lung ventilation/perfusion imaging also experienced comparable decreases in reimbursement since 2003, when adjusting for inflation, the study found.
As a result of these shifts, imaging exams historically thought to be expensive are now comparable in reimbursement to other modalities. Although decreasing exam times may reduce costs and improve patient access, “the cost of MRI is not proportional to the exam slot,” the authors noted. That’s because there are fixed costs associated with MRI, including scheduling and safety screening. Plus, reductions in acquisition time and the number of acquired sequences may not necessarily lead to reductions in overall exam time.
“Maintaining appropriate reimbursement for shortened MRI exams is needed to offset fixed costs and maintain patient access to MRI,” the authors contend. “Access to MRI is significantly worse for areas with a higher area deprivation index, including rural areas where current reimbursement schedules are already unable to sustain access to MR. As a result, many patients are less likely to receive evidence-based and medically indicated MRI exams.”
Huang and colleagues expressed concern that reductions in reimbursement for shortened MRIs could push health systems away from implementing these protocols and investing in new abbreviated technology. They noted that there may be scenarios when it’s appropriate to pay less for an abbreviated MRI, including when no sedation is required nor radiologist monitoring or add-on sequences, among other additional factors.
“This study was also driven by the common misunderstanding that there remains a need to drive down the cost of MRI further to be comparable to other modalities,” the authors wrote. “As this analysis has shown, dramatic decreases in reimbursement for MRI have already occurred, and the reimbursement for MRI is now comparable to other imaging modalities. Despite these data, the perception of MRI as an expensive exam persists, as many requesting physicians are unaware of the changing reimbursement landscape.”
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.