Dc. Levin et al., SELF-REFERRAL IN PRIVATE OFFICES FOR IMAGING STUDIES PERFORMED IN PENNSYLVANIA-BLUE-SHIELD SUBSCRIBERS DURING 1991, Radiology, 189(2), 1993, pp. 371-375
PURPOSE: To define the frequency of physician self-referral for diagno
stic imaging studies. MATERIALS AND METHODS: High-volume radiographic
(n = 65) and ultrasound (US) (n = 29) procedural codes in claims filed
by Pennsylvania Blue Shield subscribers were analyzed to determine pr
ivate-office (nonhospital) utilization of these examinations by radiol
ogists and nonradiologists during 1991. A total of 787,703 radiographi
c and 159,281 US claims were filed. RESULTS: Nonradiologists self-refe
rred 550,878 radiographic examinations (69.9%) and 99,931 US examinati
ons (62.7%). Patterns of utilization varied considerably by anatomic c
ategory: The imaging studies with the highest rates of utilization by
nonradiologists were skeletal radiography, vascular US, and obstetric
and pelvic US. Aggregate reimbursement allowance by Pennsylvania Blue
Shield for all examinations in these 94 codes was approximately $68 mi
llion, of which $44 million (65%) went to nonradiologists. CONCLUSION.
These data indicate that widespread self-referral for imaging studies
occurs in nonradiologists' private-office practices and thereby raise
concern about the potential for overutilization.