11 Year Trends in Ischemic Heart Testing in the US, Based on CMS Data

Background: Traditional Medicare is reimbursed by the Centers for Medicare & Medicaid Services (CMS), and those outside of advantage plans do not require prior authorization, thus enabling easier choices by health care providers. At the same time, there are increasing choices in testing for noninvasive ischemic heart disease, including traditional exercise treadmill testing (ETT), treadmill or pharmacologic testing with stress echocardiography (SE) or single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), positron emission tomography (PET/CT) MPI, and stress perfusion CMR (Stress MR). Anatomical testing is also a potential choice with coronary computed tomographic angiography (CCTA). Given these choices, and with available scanners in the hospital or office setting, the trend of ischemic heart testing within the United States, and in particular stress MR, is not known.

Methods: CMS data was evaluated using Current Procedural Terminology (CPT®) codes, are standardized, five-digit numerical language created by the American Medical Association to report medical, surgical, and diagnostic procedures and services. These were queried by year and volumes and tabulated as below.

Results: The most recent available data was from the year 2023, and 11 years of data was reviewed, and displayed (Figure 1). ETT decreased 32.7%. While there are approximately 5.5 times more SPECT MPI than stress echocardiograms performed, they both decreased approximately 40%. There was a 314% increase in the number of CCTAs performed. While PETs have been performed for more than a decade, the newer PET/CT code has been available since 2020, in these four years, there has been a 221.7% increase. Stress MR increased 138.7% during this time, but the overall volumes are lower.

Conclusion: Despite more than doubling in the past 11 years, the overall volume of stress perfusion MR performed in the US (based on billing data from CMS) is considerably lower than the other modalities available. Despite the widespread prevalence of MRI scanners, these data need further exploration.

11 Years of Ischemic Heart Testing in the US (2013-2023) Based on CMS Data from CPT(R) Codes