Evolution of Medicare/Medicaid imaging reimbursements from 2003 to 2025

RATIONALE AND OBJECTIVES: Cost often weighs heavily in a physician's decision to request a diagnostic imaging exam. Further, the reimbursement for shortened, i. e. focused or abbreviated MRI exams is currently undefined at a systematic level. The purpose of this study is to examine the reimbursement of common imaging exams, as a surrogate for cost, and its evolution over the past two decades to frame a discussion on the appropriate reimbursement for both focused and abbreviated MRI exams. MATERIALS AND METHODS: Common indications from the American College of Radiology (ACR) Appropriateness Criteria were used to select common imaging exams. Centers for Medicare & Medicaid Services (CMS) fee schedules from 2003 through 2025 were reviewed, and reimbursement trends analyzed over time. Inflation correction was performed using correction factors provided by the Bureau of Labor Statistics. RESULTS: Reimbursement for all imaging exams decreased substantially from 2003 through 2025. This effect was most prominent for MRI with a mean decrease of 1004. 33 (76. 5 %), range 590. 01-1629. 61 (64. 0-83. 6 %) from peak reimbursement during this period until 2025. CT also experienced a large but relatively smaller decrease in mean reimbursements of 466. 10 (69. 1 %), range 61. 13-858. 56 (38. 2-81. 7 %). Ultrasound, radiography, and lung ventilation/perfusion imaging experienced comparatively lower decreases in reimbursement. CONCLUSION: Large decreases in CMS reimbursement for many imaging modalities has occurred over the past two decades, disproportionately affecting MRI with reimbursement now comparable to alternative modalities. 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.