Variability in technical fee billing for cardiac CT across congenital cardiac centers

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography Pub Date : 2025-01-01 DOI:10.1016/j.jcct.2024.12.089

Spencer Barfuss , Corinne Ballard , Bethany Marullo , Jake Zimmerli , Luke Linscott , Cody Coonradt , B. Kelly Han

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引用次数: 0

Abstract

Background

Cardiac Computed Tomography (CCT) is increasingly used to provide 2D, 3D and 4D information in patients with congenital heart disease of all ages. Historically, negotiated rates for professional and technical fees associated with cardiac imaging were confidential, with variability in professional, technical and global charges, reimbursement and cost to patients for the same current procedural terminology (CPT) code at different institutions. Billing transparency is a key component of both the CARE act passed in 2020 and the Health Care PRICE Transparency Act 2.0 passed in 2021. Institutional technical fees and negotiated insurance rates by CPT billing code are now publicly available and can be compared between institutions.

Methods

A cohort of congenital heart disease programs was identified as the top 50 programs by procedural volume (Society of Thoracic Surgeons database) and by national rankings (US News and World Report). The publicly available negotiated reimbursement rates for the technical component of billing for CPT codes used for CHD CCT (75572, 75573, and 75574) at each center was determined (trybilly.app). The cash price, average insured price and the range of negotiated insured prices for the technical component of CHD CCT were recorded. The variability of technical fee charges for programs were calculated as median, IQR and range. Technical fee correlation to RVUs was also calculated. Professional fee and global procedural fees are not available for comparison.

Results

For the 75572 code, the median charge was $1209.50, IQR (783.50, 1673.75), and range was (49,2618). For the 75573 code, the median charge was $958, IQR (718,1403), and range (60,2622). For the 75574 code the median charge was $1060, IQR (833.5,1604), and range (61,2948). There was a 53-fold difference in technical fee charges for C CT between low and high negotiated insurance prices. Charges for CCT in CHD were not correlated with US News rankings or surgical center volume. There was no correlation between RVUs and technical fees.

Conclusion

There is significant variability in the charges for the technical component of CCT in CHD, not correlated with national ranking or surgical volume. Variability in charges for identical services across centers may have a disproportionate impact on uninsured and underinsured populations. and lead to inequity. This data may inform negotiations for reimbursement for this time-consuming skill set. The variability of technical fee associated with CT for CHD has not been previously analyzed or compared by national ranking or surgical volumes.

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跨先天性心脏中心心脏CT技术收费的差异。

背景：心脏计算机断层扫描（CCT）越来越多地用于提供所有年龄段先天性心脏病患者的2D， 3D和4D信息。从历史上看，与心脏成像相关的专业和技术费用的谈判费率是保密的，不同机构的专业、技术和全球收费、报销和患者的成本都存在差异，使用相同的现行程序术语（CPT）代码。账单透明度是2020年通过的《医疗保健法案》和2021年通过的《医疗保健价格透明度法案2.0》的关键组成部分。机构技术费用和按CPT计费代码协商的保险费率现在是公开的，可以在机构之间进行比较。方法：根据手术量（胸外科学会数据库）和国家排名（美国新闻与世界报道）确定先天性心脏病项目队列为前50名。确定了每个中心用于CHD CCT（75572、75573和75574）的CPT代码的计费技术部分的公开协商报销率（trybilly.app）。记录CHD CCT技术部分的现金价格、平均保险价格和协商保险价格范围。项目技术收费的可变性计算为中位数、IQR和范围。计算了技术费用与rvu的关系。没有专业费用和全球程序费用可供比较。结果：对于75572代码，中位数费用为1209.50美元，IQR为（783.50,1673.75），范围为（49,2618）。对于75573代码，中位数收费为958美元，IQR（718,1403）和范围（60,2622）。对于75574代码，中位数收费为1060美元，IQR（833.5,1604）和范围（61,2948）。C - CT的技术收费在低保险价格和高保险价格之间有53倍的差异。冠心病CCT收费与US News排名或手术中心数量无关。rvu与技术费用之间没有相关性。结论：冠心病CCT技术部分收费存在显著差异，与国家排名和手术量无关。不同中心相同服务收费的差异可能对未参保和参保不足的人群产生不成比例的影响。并导致不平等。这些数据可以为这个耗时的技能的报销谈判提供信息。与冠心病CT相关的技术费用的可变性以前没有通过国家排名或手术量进行分析或比较。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Computed Tomography CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

7.50

自引率

14.80%

发文量

212

审稿时长

40 days

期刊介绍： The Journal of Cardiovascular Computed Tomography is a unique peer-review journal that integrates the entire international cardiovascular CT community including cardiologist and radiologists, from basic to clinical academic researchers, to private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our cardiovascular imaging community across the world. The goal of the journal is to advance the field of cardiovascular CT as the leading cardiovascular CT journal, attracting seminal work in the field with rapid and timely dissemination in electronic and print media.