Changes in Current Procedural Terminology Coding and its Effect on Specialty-Level Utilization of Musculoskeletal Ultrasound

ABSTRACT Purpose Concerns regarding increasing utilization of non-vascular extremity ultrasound (US) imaging led to the Current Procedural Terminology (CPT) Editorial Panel separating a singular billing code into distinct comprehensive and focused examination codes with differential reimbursement. We explore this policy change's temporal association with utilization. Methods Using Physician/Supplier Procedure Summary (PSPS) Master Files, we identified all non-vascular extremity US services billed for Medicare fee-for-service beneficiaries between 1994 and 2017. These included generic (CPT code 76880 from 1994-2010), complete (code 76881 from 2011-2017), and limited (code 76882 from 2011-17) examinations. Annual utilization per 100,000 beneficiaries was computed and stratified by billing specialty. Compound annual growth rates were calculated. Results Radiologists and podiatrists were the top two billing specialties for nonvascular extremity US examinations. From 1994-2010, radiologist services increased 6.1% annually. Following the 2011 code separation, radiologists’ utilization increased 2.7% annually for complete and 12.3% for limited exams. Between 1994 and 2017, radiologists’ market share decreased 72.8% to 40.4%. From 1994-2010, podiatrist services increased 87.1% annually. Following the code separation, podiatrists’ annual utilization growth stabilized 0.4% for complete and 0.6% for limited exams. Podiatrists’ market share was 9.1% in 2001, peaked at 31.3% in 2009, and declined to 14.3% in 2017. Conclusions Prior rapid growth in extremity nonvascular US for podiatrists slowed considerably following CPT code separation in 2011. Subsequent service growth has largely been related to less costly, focused examinations performed by radiologists. Further study may help better understand how CPT coding changes alter imaging utilization more broadly.