Rapid brain MRI cuts payer costs, not patient costs

Rapid brain MRI protocols reduced payer reimbursement but did not lower patient out-of-pocket costs, according to a Pediatric Radiology study.

Shireen Hayatghaibi, PhD, of Cincinnati Children’s Hospital Medical Center and the University of Cincinnati Medical Center, and colleagues compared commercially insured patients who underwent outpatient noncontrast brain MRI or rapid brain MRI at a quaternary academic children’s hospital.

Researchers included 147 standard brain MRI exams and 166 rapid brain MRI exams coded with the 52 modifier. Medicaid exams were excluded because they did not include patient cost sharing.

Most exams included cost sharing. That applied to 77% of standard MRIs and 69% of rapid MRIs.

Payer reimbursement was higher for standard MRI than rapid MRI, at a mean of $2,760 versus $1,986. The difference was statistically significant.

Among exams with cost sharing, patient out-of-pocket costs were similar. Mean costs were $1,206 for standard MRI and $1,285 for rapid MRI.

Commercial payers did not recognize the limited modifier in 43% of rapid MRI claims. When that happened, reimbursement was comparable to standard diagnostic MRI, according to the authors.

The authors said inconsistent recognition of the modifier shows a need for updated CPT codes and reimbursement policies aligned with rapid MRI use.

Study limitations included its single-institution design, lack of detailed insurance benefit-plan data, and restriction to brain MRI examinations.