Exam Type-Driven Variations in MRI Efficiency: Throughput, Billing, and RVU Across a Multi-Site Academic Health System

Purpose: Magnetic resonance imaging (MRI) is a time-intensive and costly imaging modality. System-level data on reimbursement and work relative value units (RVUs) per unit of scanning time is not available in the literature. This study quantifies procedure code variations in a large academic system to optimize throughput, revenue, and protocols.

Methods/Materials: We analyzed one year of data (1/1/2023–12/31/2023) from 15 MRI scanners at 8 sites in a large academic health system, consolidating same-day exams per patient. Scan duration (“exam start” to “exam complete”) excluded outliers ( < 5th/>95th percentile) and incomplete records. Work RVUs were from 2023 CMS Physician Fee Schedule via CPT codes; reimbursement (professional + technical) from institutional billing. Aggregated by CPT code, we calculated utilization, mean duration, throughput (where available), reimbursement/RVU per minute (top-10 focus). Kruskal–Wallis and Mann–Whitney U tests were used to examine differences by exam type.

Results: 61,599 MRI examinations (67 procedure codes) were performed. Reimbursement per minute varied significantly across exam types (p < 0.001, Kruskal–Wallis). The five highest-volume exams—MRI Brain W/O & W dye (21.8%), Brain W/O dye (10.5%), Abdomen W/O & W dye (9.4%), Pelvis W/O & W dye (7.0%), and Lumbar Spine W/O dye (5.8%)—comprised 54.4% of volume, with outpatient reimbursement per minute ranging from $8.52 (Lumbar Spine) to $12.81 (Abdomen).
The top ten exams accounted for 72.7% of volume. Within these, abdominopelvic protocols had the highest reimbursement ($6.96–$12.81/min) and RVUs (0.19–0.35/min), while non-contrast spine and lower-extremity joint exams had the lowest ($4.43–$9.14/min; 0.12–0.23/min). High-volume brain and spine exams generated significantly lower reimbursement and RVUs per minute than abdominopelvic exams in both inpatient/outpatient settings (p < 0.001). Overall, MRI scanning averaged $8.40 reimbursement and 0.29 RVU per minute.

Conclusions: MRI procedure codes show marked variation in reimbursement and RVUs per scanner minute. High-volume brain and spine exams yield less than abdominopelvic ones due to longer protocols. Optimization of MRI protocols could improve throughput and revenue.