Perspective | How to Charge for High-Pressure Contrast Syringe Use in Enhanced MRI Procedures
Published:
2025-11-13
MRI-related billing items are a major area of improper use of medical insurance funds. Due to healthcare institutions' inaccurate understanding of fee standards, they frequently encounter issues such as duplicate charges and overcharging when performing MRI scans. Notably, the practice of charging for high-pressure contrast injectors during enhanced MRI examinations has become one of the most common challenges facing medical facilities. Drawing from case-handling experience, the author provides an overview of how high-pressure injector fees are collected in Shandong Province, along with an explanation of the underlying rationale behind these charges.
MRI-related billing practices have become a major area of improper use of medical insurance funds. Due to healthcare institutions' inaccurate understanding of fee standards, they frequently encounter issues such as duplicate charges and charges exceeding the prescribed limits during MRI scans. Among these problems, the practice of charging for high-pressure contrast injectors specifically during enhanced MRI examinations remains one of the most common challenges faced by medical facilities. Drawing from personal experience in handling such cases, the author examines the situation in Shandong Province. High-pressure syringe An introduction to the fee collection process, along with an explanation of the underlying rationale.
I. Case Overview
During an enhanced MRI scan at a certain hospital, the hospital charged a usage fee for the high-pressure contrast injector based on its consumable materials. Although the hospital had implemented the "zero markup" policy for medical consumables as required by the Pilot Plan for Deepening Medical Service Price Reform, it was still deemed to have overcharged by the administrative department overseeing the medical insurance fund. As a result, the hospital was not only ordered to reimburse the corresponding medical insurance funds but also faces hefty fines.
II. Legal Basis
According to the "Shandong Province Public Medical Institution Medical Service Item Prices (2023 Edition)" (hereinafter referred to as the "Service Item Prices"), Section 2102 on MRI Scanning clearly states: "3. An additional fee of 100 yuan will be charged for single-cylinder use with a high-pressure injector, and 150 yuan for dual-cylinder use." Therefore, when medical institutions perform enhanced MRI scans using disposable high-pressure contrast injection systems, they should charge an additional fee based on the actual number of consumables used.
"The Price List for Service Items" will categorize magnetic resonance imaging scans under the medical technology and diagnostic treatment category, based on the "Shandong Province Public Medical Institutions' Catalog of Single-Use Materials Subject to Additional Charges" (hereinafter referred to as "the... Materials Catalog 》) stipulates that the one-time materials for medical technology diagnostic and treatment procedures that may be charged separately do not include high-pressure contrast injectors. Therefore, when medical institutions perform enhanced MRI scans using disposable high-pressure contrast injectors, they are not permitted to charge a fee for the consumables.
III. Rationality Analysis
Since the additional charge for the high-pressure contrast injector specified in the "Materials Catalogue" for MRI scans is lower than the actual usage costs incurred by medical institutions, does this indicate that the standards set forth in our province's "Materials Catalogue" are too low, potentially undermining medical facilities' willingness to perform enhanced MRI scans?
The author examined the prices of commonly available high-pressure contrast injection syringes on the market. Generally, domestically produced models range from 30 to 70–80 yuan, while imported ones typically cost between 100 and 150 yuan. Although products at different price points may vary in technical aspects such as injection flow rate accuracy, pulse control, and compatibility, the surcharge standards outlined in the "Service Item Prices" are based on the cost of mainstream products that meet standard diagnostic needs. For instance, the Shandong Provincial Public Health Clinical Center recently published a transaction announcement—No. YGHC20240037—for single-use items. High-pressure contrast syringe and accessories The price for the single-use high-pressure contrast injection syringe and its accessories is 36 yuan per set, with item number YGHC2024008. Additionally, the price for each individual single-use high-pressure contrast injection syringe and its accessories is also listed as 36 yuan. It is evident that the cost standards outlined in the "Materials Catalogue" are sufficient to cover the expenses associated with using the high-pressure contrast syringes. In this particular case, the hospital’s purchase price for the high-pressure contrast syringes exceeds the rate specified in the "Materials Catalogue," indicating that the hospital’s individual procurement costs are higher than the average societal cost used as the basis for policy formulation. Therefore, this discrepancy does not imply that the standards set forth in the "Materials Catalogue" are unreasonable.
If allowing charges based on actual costs could more accurately reflect expenditures, it would also place higher demands on the budget management and price regulation of the medical insurance fund, potentially increasing the risk of fund misappropriation due to lack of transparency in the procurement process. Currently, the adoption of a fixed surcharge standard is driven by considerations of simplified management, standardized practices, and proactive risk prevention. Furthermore, the nation has formulated the “ Basic Medical Insurance Drug List The fundamental purpose is to ensure the basic medical needs of urban employees and maintain a balanced budget for the basic medical insurance fund. The prices defined jointly by the "Service Item Prices" and the "Material Catalogue"—prices that are reimbursable by the medical insurance fund—are established on the basis of meeting essential medical needs, fully covering the primary costs associated with delivering relevant diagnostic and treatment services. However, the high-quality, high-pressure contrast injectors used by medical institutions to enhance examination effectiveness clearly exceed the scope of basic medical requirements, and thus their costs should naturally not be borne by the medical insurance fund.
IV. Summary
In summary, medical institutions in Shandong Province that use high-pressure contrast injectors during enhanced MRI scans should charge an additional fee based on the number of high-pressure injectors used, as specified in the project guidelines. However, they are not permitted to collect charges for the consumables associated with these high-pressure injectors. If, for clinical needs, a higher-priced high-pressure injector must be employed, this additional cost also cannot be covered by the medical insurance fund. Medical facilities may choose not to submit the procedure to the insurance system at all, allowing patients to bear the full expense themselves. Nonetheless, it is crucial to inform patients beforehand that using a premium-quality high-pressure injector is a self-funded service. Such use can only proceed after obtaining the patient's written consent. Failure to do so would still constitute a violation of Article 15, Paragraph 2, of the Regulations on the Supervision and Administration of Medical Insurance Fund Usage, potentially exposing the institution to penalties from the medical insurance administrative authorities.
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