Trends in the Utilization of CT Angiography and MR Angiography of the Head and Neck in the Medicare Population

Purpose: The aim of this study was to analyze trends in the utilization of CT angiography (CTA) and MR angiography (MRA) of the head and neck in the Medicare population over a 6-year interval. Methods: Nationwide Medicare Part B fee-for-service databases were reviewed. Current Procedural Terminology (R) codes for CTA and MRA of the head and neck were selected. MRA codes included studies without contrast, with contrast, and without and with contrast. Yearly and aggregate procedure volumes were compared for each Current Procedural Terminology code and modality. Data were also analyzed regarding contrast utilization and cost. Results: From 2002 to 2007, the volume of head CTA increased by 827%, and the overall volume of head MBA increased by 39%. The year-to-year percentage increase in overall volume of head MRA declined throughout the study period; almost all of the increase in the overall volume of head MRA occurred from 2002 to 2005. The volume of neck CTA increased by 1,074%, and the overall volume of neck MRA increased by 31%. An 18% decrease in the volume of neck MRA without contrast was offset by a 104% increase in the volume of neck MRA using contrast. The year-to-year percentage increase in the overall volume of neck MRA declined from 2002 to 2005; there was a decrease in volume of 3% from 2005 to 2007. From 2002 to 2007, when considering all study types, procedure volume increased by 71%; aggregate allowable charges increased by $181 million. Examinations using contrast increased by 235%. In 2002, 23% of examinations used contrast; in 2007, 46% of examinations used contrast. Conclusions: The rate of growth for head and neck CTA was dramatically higher than for MBA. Neck MBA using contrast also showed substantial growth. The Medicare population is now receiving more contrast material and radiation to noninvasively assess the arterial vasculature of the head and neck.