Compensating Radiologists for Contrast Supervision

New revenue opportunities have opened up for radiology groups with CMS’ extension of flexibilities for the virtual supervision of radiology studies performed with contrast media. The extension allows facilities to provide Level 2 diagnostic tests, including CT and MRI scans, with a remotely located supervising provider through (at least) December 31, 2025. Before the COVID-19 epidemic in 2020, CT and MRI with contrast procedures had to be supervised by onsite physicians who were immediately available to provide assistance and direction during the procedure, and the allowance of virtual supervision was only meant to be temporary. With virtual supervision rules still in place (and likely to be extended again), a radiologist or other type of provider who meets the criteria set by CMS can now supervise procedures via two-way audio/video communications technology.

Seeing the business opportunity, some radiology groups have begun offering outsourced virtual contrast supervision services. These services are separate from reading studies onsite at a facility, which a different radiology group may do. Not surprisingly, other radiology groups facing physician shortages and increased costs are seeing these business moves being made and are approaching their partner facilities to seek compensation for the contrast supervision they provide. The basis for the ask is that contrast supervision costs money to provide but generates no revenue for the group as it is part of the technical component of a procedure being billed by the facility.

Given these market dynamics, appraisers are increasingly asked to value contrast supervision. There are several things to consider in these types of engagements. First, actual market data for these services is beginning to become available. More than one group has openly advertised their rates online to provide virtual supervision services for facilities, with pricing that ranges from $45 to $150 per hour, depending on the commitment/frequency of the services.

Valuing contrast supervision from an à la carte perspective (which may make the most sense when there is no broader service arrangement between the parties), online pricing can serve as a reference point. For the same purpose, we would also consider using compensation survey data to help establish value. We would start by looking at hourly rate benchmarks for qualified providers with a lower cost point than radiologists. (CMS allows more than just radiologists to provide the service; however, supervising must be provided by a trained and qualified professional under the general oversight of a radiologist.) These include non-radiologist physicians and advanced practice providers (“APPs”). The hourly cost for these providers may be similar to the online rates above.

Alternatively, we would consider benchmark data for radiologists. However, we would think that radiologists providing contrast supervision services – even if they are required to be onsite – provide the service concurrently with performing reads and other professional work.  In that case, looking at on-call compensation benchmarks may be appropriate. The 2024 BFMV Physician Call Coverage Burden & Compensation showed that the median diagnostic radiology call payment was $2,100 per diem, which translates to $87.50 per hour, near the online rates' midpoint.

Facts and circumstances would come into play, but data like these would be informative during a valuation of contrast supervision on an individually priced basis. The process would be more complex for groups seeking compensation under a broader radiology services agreement. However, providing contrast supervision can help a radiology group make a case for supplemental payments and certain physician compensation levels to their facility partners.

For more information on valuing radiology services or BFMV benchmarks for radiology call coverage services, reach out to us via our website at buckheadfmv.com. Physicians participating in our upcoming call survey will receive free access to the results. A link to join the study is on our website. Participation is open through May 2025.