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The mission of the Harvey L. Neiman Health Policy Institute® is to establish foundational evidence for health policy and radiology practice that promotes the effective and efficient use of health care resources and improves patient care.

September 12, 2019

New Research Finds Increased Roles of Non-physician Providers in Diagnostic Imaging Services

Non-physician providers (NPPs) increasingly perform imaging-guided procedures, but their roles interpreting imaging has received little attention. In a Harvey L. Neiman Health Policy Institute study published in the American Journal of Roentgenology, researchers identified the specific types of diagnostic imaging services rendered by NPPs in the Medicare population and studied state-level variation in the provision of such services.

The researchers used 100% aggregate Medicare claims data from 1994-2015 to identify all diagnostic imaging services, including those billed by NPPs and categorized them by imaging modality and body region. Using a 5% sample of individual Medicare patient data from 2004-2015, they additionally assessed state level variation.

“Between 1994 and 2015, diagnostic imaging utilization rates for Medicare fee-for-service beneficiaries increased 24%. During this same period, diagnostic imaging services billed by NPPs increased 14,711%, from 36 services to 5,332 services per 100,000 beneficiaries,” said Valeria Makeeva, MD, a radiology resident at Emory University. “Despite that increase, NPP billed diagnostic imaging represented only 0.01% and 1.27% of all such services in 1994 and 2015, respectively.”

Makeeva and her colleagues found that between 1994 and 2015, radiography and fluoroscopy (RF) accounted for 94% of NPP billed imaging services. However, it still represented only 0.01% (1994) and 2.1% (2015) of all Medicare RF services, indicating that despite the increasing roles of NPPs across the United States, they rarely interpret diagnostic imaging studies.

“Although considerable state-to-state variation exists in the rates in which NPPs render diagnostic imaging services, likely in part related to unique state level scope of practice laws and regulations, these rates are uniformly low,” noted Richard Duszak, MD, FACR, professor of radiology and imaging sciences at Emory University and senior affiliate research fellow at the Neiman Institute. “At present, the near-term likelihood of NPPs acquiring substantial diagnostic imaging market share is extremely low.”

To obtain a copy of the study or to arrange an interview with a Neiman Institute spokesperson, contact Nichole Gay at (703) 648-1665 or



About the Harvey L. Neiman Health Policy Institute

The Harvey L. Neiman Health Policy Institute® is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care.Visit us at and follow us on Twitter, LinkedIn and Facebook.


Nichole Gay
Harvey L. Neiman Health Policy Institute