Reimbursement for diagnostic imaging services under Medicare has declined sharply over the past two decades, with MR bearing the largest cuts, according to a recent retrospective analysis of CMS fee schedules from 2003 through 2025.

The study, conducted by researchers affiliated with the University of Michigan, evaluated trends across a broad range of imaging modalities using HCPCS codes and American College of Radiology (ACR) Appropriateness Criteria. Adjusted for inflation, average Medicare reimbursement for MR exams fell by 76.5%, with individual MR codes declining between 64.0% and 83.6% from their peak values. In comparison, CT reimbursements decreased by an average of 69.1%, with declines ranging from 38.2% to 81.7%.

Ultrasound, radiography, and nuclear medicine experienced more modest declines. For example, reimbursement for screening abdominal ultrasound dropped by 28.8% from its peak, while X-ray exams of the spine fell by roughly 44% to 47%.
The convergence in reimbursement between modalities was seen across nearly all anatomical regions. For instance, in head and brain imaging, the difference in reimbursement between MR and CT narrowed from a range of $280 to $737 in 2003 to just $52 to $143 in 2025. In spine and extremity imaging, similar trends were observed, with MR reimbursement now closely aligned with CT for comparable studies.

The findings are part of a broader argument that focused and abbreviated MR exams, designed to answer specific clinical questions in less time, should be reimbursed at the same rate as traditional comprehensive MR studies. The authors caution against tying reimbursement to exam duration, noting that fixed costs, suite turnover time, and radiologist interpretation time do not scale linearly with exam length.

"Reductions in acquisition time, exam time, and the number of images and sequences acquired may not provide a basis for corresponding reductions in reimbursement," the authors wrote.

The study concludes that MR is no longer a disproportionately costly imaging modality and that further reductions in reimbursement, particularly for shortened protocols, may threaten access and discourage innovation.

The study can be read here.

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