Dual-energy X-ray Performance Among Medicare Beneficiaries: 2005-2019

Purpose/Aims

To provide updated trends in DXA number, utilization rates, place of service and interpreter specialty based on a Medicare population dataset.

Rationale/Background

DXA exam utilization rate, place of service and interpreters have changed since 2005.

Methods

The Medicare Physician/Supplier Procedure Summary Limited Data Set between 2005-2019 was used. All claims with CPT DXA codes 76075, 76076, 77080, 77081 were retained. Annual counts of DXA scans and rates per 10,000 Medicare beneficiaries were calculated. Annual distributions (%) of DXA scans performed by place of service (Office, Outpatient hospital [OH], Other), provider type (Radiologist, Non-Radiologist, Advanced Practice Practitioner [APP]), and interpreter specialty (Radiology, Primary Care, Ob/Gyn, Rheumatology, Endocrinology, Other) were described. Linear regression was used to identify significant trends (significance assigned at p < 0.05) of the mean annual share of DXA utilization by place of service, provider type, and specialty.

Results

Annual DXA use/10,000 beneficiaries peaked in 2008 at 832, declined to 656 in 2015 and subsequently increased (p < 0.001) by a mean of ∼38 to 807 in 2019 (Figure 1). In 2005, 70.7% of DXAs were performed in office settings with 28.6% acquired in OH. Since 2005, number of DXAs performed in OH increased 1.8%/yr, reaching 51.7% in 2019, and decreased (p < 0.001) 1.8% at office sites. In 2005, 53.7% were interpreted by non-Radiologists and 43.5% by Radiologists. Across the study period the mean proportion interpreted by Radiologists increased (p-values for trend < 0.001) in both office (0.3%/yr) and OH (2.0%/yr) settings, such that by 2019, Radiologists read 73.5% of DXA exams and non-Radiologists 22.8% (Figure 2). A decline in interpretation (p < 0.001) was observed for Primary Care (mean 1.5%/yr), Rheumatology (mean 0.3%/yr) and Ob/Gyn (mean 0.2%/yr) with no significant change for Endocrinology. The share of DXA interpreted by APPs increased by a mean of 0.1%/yr (p < 0.001) from 2005-2019.

Implications

DXA number and utilization rate among Medicare beneficiaries has increased since 2015 and returned to 2005 levels. Office DXA rates have declined since 2005 with 51.7% of all scans now occurring in an outpatient hospital setting. DXA interpretation by Radiologists and APPs increased while most other specialties declined. Radiologist DXA interpretation has increased in both settings such that Radiology interpreted 73.5% of all DXAs submitted to Covered Medical Services for reimbursement in 2019.