Functional MRI use in Medicare has stagnated after years of growth. What’s holding it back?

Clinicians’ use of functional magnetic resonance imaging has leveled off after a period of precipitous growth following the creation of a distinct CPT code to report use of this imaging service. What’s holding back fMRI and how can providers propel its proliferation?

A team of experts from Emory University recently set out to answer some of these questions, analyzing Medicare data from a 10-year period ending in 2017.

They found that fMRI use leaped from almost 18% (per 1 million enrollees) in 2007 up to 33% by 2014 and plateaued since then. This imaging approach is widely used among research and clinical practice, predominantly in the outpatient setting, and it also has value in surgical planning and understanding of psychiatric conditions. But radiologists are still the dominant users, accounting for nearly 89% of their delivery in Medicare, researchers reported in the American Journal of Neuroradiology.

“Despite the increase in the use rates of fMRI, it is possible that barriers exist to furthering expansion of fMRI services,” Solmaz Asnafi, MD, and co-authors from Emory and the Harvey L. Neiman Health Policy Institute, wrote Oct. 8.  “Current levels of fMRI use among Medicare beneficiaries might not be meeting the population-level clinical needs,” they added.

Asnafi et al. theorized that decreasing reimbursement for these exams may be one culprit. Payment for CPT code 70554 dropped from $618 in 2017 down to $455 a decade later. Also, competing technologies for presurgical evaluation of refractory focal epilepsy and functional brain mapping have grown. Those include magnetoencephalography, with growing expertise in MEG possibly also “blunting the curve of fMRI use in recent years.” Hardware, software, the required level of experience and dedicated time for these exams serve as further roadblocks, the research team noted.

Neurology and neurosurgery account for 3 of the 4 main applications for fMRI, and yet, radiologists have remained the prevailing players in this realm at 86.4% at the start of the study period and 88.6% 10 years later.

This data will have important implications, amid an increasingly aging U.S. population. The researchers cited estimates that about 40% of new national cases of brain and central nervous system cancers occur in the 65-and-older population.

“Thus, it may be expected that the rate of brain surgery for these tumors will increase as well, particularly because the extent of tumor resection positively correlates with improved patient outcomes, and the need for preoperative fMRI should also increase,” the authors noted.

Read more in AJNR here.