Reimbursement (USA)

In the United States, the fee paid for a cardiac MRI is often similar to those of other MRI studies and of other cardiac imaging tests. It is ironic that some physicians use the cost of a cardiac MRI as a reason not to order it. Try asking a physician what they think the cost of a cardiac MRI is. Many physicians believe it’s $2,000 or more!

Payments for diagnostic imaging are governed by many factors such as the identity of the 3rd party payer, the geographic locale, and the imaging facility (i.e. hospital vs. office setting). However, to serve as a baseline, I’ve listed the prices for various cardiac MRI CPT codes below. The fees shown are for Manhattan, New York, and are from the 2021 Medicare Physician Fee Schedule, which is published annually by the Center for Medicare and Medicaid Services (CMS).

CPT Code           Cardiac MRI Description                                                                                                         Global Fee

75557                 for Morphology and Function w/o contrast                                                                         $410.98

75559                 for Morphology and Function w/o contrast: with stress imaging                                     $570.59

75561                 for Morphology and Function with and w/o contrast                                                         $499.17

75563                 for Morphology and Function with and w/o contrast: with stress imaging                     $587.37

75565                 for velocity flow mapping                                                                                                          $63.23

 

For comparative purposes, the fees for some other imaging tests are listed below.

CPT Code           CPT Description                                                                                                                        Global Fee

74181                 MRI of the Abdomen w/o contrast                                                                                         $262.76

74183                 MRI of the Abdomen with and w/o contrast                                                                         $461.06

78452                 Myocardial perfusion (SPECT)                                                                                                  $580.02

 

The CMS 2021 Medicare Physician Fee Schedule can be accessed here for those who are interested in determining the fees of other CPT codes and/or other geographic locations. A detailed explanation on how to use the searchable Medicare Physician Fee Schedule can be found here.

Based on the above data, one could argue that the fees for cardiac MRI should be higher. Compared to other MRI studies, a cardiac MRI often takes longer to perform and requires additional software and hardware. The quantitative analysis of cardiac MR images also takes longer to perform and requires special software. Physicians, technologists, and nurses require specialized training in order to perform cardiac MRI studies. Finally, the information derived from cardiac MRI is often more accurate and more comprehensive than that obtained by other cardiac imaging tests. Nevertheless, today, the fees for providing cardiac MRI services are often similar to those of other tests.