Financial analysis of intravascular ultrasound-guided transvenous biopsy in an outpatient Medicare population

Purpose: Intravascular US-guided transvenous biopsy (IVUS-TVB) is a recently described biopsy technique suited for deep targets adjacent to the inferior vena cava or iliac veins in lieu of CT-guided percutaneous needle biopsy (CT-PNB). Because IVUS-TVB requires expensive equipment including a side-viewing phased-array intracardiac echocardiography IVUS catheter, it is important to explore the economics of this novel biopsy approach. The purpose of this study was to perform a financial analysis of IVUS-TVB in comparison to CT-PNB in an outpatient Medicare population.

Materials and Methods: Financial modeling was performed assuming reimbursement in either the outpatient hospital-based setting or the ambulatory surgery center setting using Medicare facility fee national averages, excluding professional fees. Procedure facility costs were separated into total variable labor (TVL), total variable supply (TVS), total variable other (TVO), and total fixed cost (TFC). Device costs were estimated for IVUS-TVB and CT-PNB to determine Medicare fees available to cover the remaining TVL, TVS, TVO, and TFC.

Results: IVUS-TVB device cost was estimated at $2,958 for supplies including an IVUS catheter, transjugular liver biopsy kit, and vascular sheath. In the outpatient hospital-based setting transcatheter biopsy code 37200 provides $4,870, yielding $1,912 to cover the remaining TVL, TVS, TVO, and TFC. Thus, if IVUS-TVB is the only feasible radiological biopsy approach, the procedure can be performed with a similar financial margin as nephrostomy tube placement, for example ($1,710 for code 50432 less supplies). If either IVUS-TVB or CT-PNB is possible, CT-PNB code 49180 provides $1,399 after supplies to cover the remaining TVL, TVS, TVO, and TFC, which is $513 less than IVUS-TVB. However, in the ambulatory surgery center setting, transcatheter biopsy code 37200 provides $2,423, which is $535 less than IVUS-TVB supplies.

Conclusion: This study demonstrated that, despite use of expensive supplies, IVUS-TVB provides a similar or better financial margin in the Medicare outpatient hospital-based setting compared to other procedures including CT-PNB. On the contrary, IVUS-TVB reimbursement fails to cover device costs in the ambulatory surgery center setting, necessarily incurring a loss. Nonetheless, the financial feasibility in the outpatient hospital-based setting should encourage interventional radiologists to incorporate this technique into their practices for select patients.