A new study by the Harvey L. Neiman Health Policy Institute has found that in the Medicare population, the utilization rates have increased in both volume and per beneficiary over the past two decades for the four most common musculoskeletal (MSK) extremity imaging modalities: radiography, MRI, CT, and ultrasound.1 Radiology was the dominant billing specialty for all imaging modalities with dominant market shares for MRI and CT. Physician offices were the most common site for imaging for all modalities except for CT, which was most commonly utilized in the hospital outpatient and inpatient settings.

These insights may have implications for radiology practice leaders in making decisions regarding capital infrastructure, workforce, and training investments to ensure the provision of optimal imagine services for extremity musculoskeletal care.

“Our results show that the utilization rates (per 1,000 Medicare beneficiaries) for all four musculoskeletal extremity imaging modalities increased over time,” says lead study author Soterios Gyftopoulos, MD, an associate professor of radiology at NYU Langone Medical Center. “The largest increase was for CT throughout our study’s time period with a 754% increase in utilization from 1994 to 2013.”

Gyftopoulos and his colleagues used billing data obtained from Centers for Medicare and Medicaid Services Medicare Physician Supplier Procedure Summary Master Files from 1994 to 2013. The Neiman Imaging Types of Service radiology claims classification system was used to identify those HCPS codes corresponding with non-vascular extremity imaging. The following increases in MSK extremity imaging were found over the past two decades: 43% for radiography, 619% for MRI, 754% for CT, and 528% for ultrasound.

“An understanding of the utilization rates of common imaging modalities is an important first step toward determining the most cost-effective imaging strategies for patients with musculoskeletal conditions,” adds Richard Duszak, MD, FACR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University and senior affiliate research fellow at the Neiman Institute. “Our findings support observations that physicians are increasingly relying on advanced imaging to ensure that their patients with musculoskeletal diseases receive the best care,” he says.


1. Gyftopoulos S, Harkey P, Hemingway J, et al. Changing musculoskeletal extremity imaging utilization from 1994 through 2013: A Medicare beneficiary perspective. American Journal of Roentgenology. Published online in advance. 2017; doi: 10.2214/AJR.17.18346