Variability in technical fee billing for cardiac CT across congenital cardiac centers

Background: Cardiac Computed Tomography (CCT) is increasingly used to provide 2D, 3D and 4D information in patients with congenital heart disease of all ages. Historically, negotiated rates for professional and technical fees associated with cardiac imaging were confidential, with variability in professional, technical and global charges, reimbursement and cost to patients for the same current procedural terminology (CPT) code at different institutions. Billing transparency is a key component of both the CARE act passed in 2020 and the Health Care PRICE Transparency Act 2.0 passed in 2021. Institutional technical fees and negotiated insurance rates by CPT billing code are now publicly available and can be compared between institutions. Methods: A cohort of congenital heart disease programs was identified as the top 50 programs by procedural volume (Society of Thoracic Surgeons database) and by national rankings (US News and World Report). The publicly available negotiated reimbursement rates for the technical component of billing for CPT codes used for CHD CCT (75572, 75573, and 75574) at each center was determined (trybilly.app). The cash price, average insured price and the range of negotiated insured prices for the technical component of CHD CCT were recorded. The variability of technical fee charges for programs were calculated as median, IQR and range. Technical fee correlation to RVUs was also calculated. Professional fee and global procedural fees are not available for comparison. Results: For the 75572 code, the median charge was $1209.50, IQR (783.50, 1673.75), and range was (49,2618). For the 75573 code, the median charge was $958, IQR (718,1403), and range (60,2622). For the 75574 code the median charge was $1060, IQR (833.5,1604), and range (61,2948). There was a 53-fold difference in technical fee charges for C CT between low and high negotiated insurance prices. Charges for CCT in CHD were not correlated with US News rankings or surgical center volume. There was no correlation between RVUs and technical fees. Conclusion: There is significant variability in the charges for the technical component of CCT in CHD, not correlated with national ranking or surgical volume. Variability in charges for identical services across centers may have a disproportionate impact on uninsured and underinsured populations. and lead to inequity. This data may inform negotiations for reimbursement for this time-consuming skill set. The variability of technical fee associated with CT for CHD has not been previously analyzed or compared by national ranking or surgical volumes.