Hidden Erosion of Medicare Part B Radiology Professional Payments: Inflation, Volume, and Case-Mix Effects, 2014–2023

Purpose: To assess trends in Medicare Part B radiology utilization and professional payments from 2014–2023, accounting for inflation, modality case mix, and Medicare Advantage (MA) enrollment.

Methods/Materials: Medicare Fee-for-Service (FFS) Part B non-institutional professional claims from 2014–2023 were extracted from the CMS Physician & Other Practitioners by Provider and Service dataset and grouped by modality (CT, MRI, radiography, US, Mammography, Nuclear med, and IR). Claims include professional payments for services done in facility and combined professional and technical payments for non-facility settings. From 2014–2023, MA penetration rose from 29.7% to 48.3% (FFS share 70.3% to 51.7%), so FFS volumes were scaled by total FFS enrollment to estimate total Medicare imaging volume and professional payments across FFS and MA enrollees. Extrapolated volumes assume similar per-capita imaging utilization between MA and FFS beneficiaries. Utilization was calculated as imaging services per 1,000 FFS enrollees. Payments were summarized annually in nominal dollars and converted to 2023 dollars using CPI-U. Total payment changes from 2014-2023 were decomposed into inflation, volume, modality mix holding inflation-adjusted 2014 rates, and per-exam rate effects.

Results: Total Medicare Part B radiology professional payments increased from $2.83B to $3.16B (+12% nominal) but were $480M below the 2014 inflation-adjusted benchmark ($3.64B), representing a 13% real decline. Per-capita CT utilization rose by 44% (520.9 to 749.4 per 1,000) and MRI rose by 36% (157.3 to 213.4 per 1,000), while radiography fell 14% (1347.3 to 1156.0 per 1,000). Case-mix shifts contributed +$502M (CT +$417M) but were outweighed by −$647M from per-exam rate erosion. Inflation-adjusted payment per exam declined for MRI (−28.0%) and CT (−26.5%). Although FFS imaging volume fell by 9%, estimated total Medicare imaging volume grew 30%.

Conclusions: Medicare Part B radiology professional payments have greatly eroded in real terms despite rising CT and MRI utilization and overall imaging demand. Nominal payment growth obscures inflation-adjusted declines in payment per exam, increasing workload pressures and challenging practice sustainability.