Magnetic Resonance Imaging

Payment mechanism

Since diagnostic MRI is usually performed in outpatient settings, the payment model depends on the payment system used in this setting: in England, the Netherlands, and countries of the Nordic region, the procedures are reimbursed solely via the diagnosis-related group (DRG) mechanism. In contrast, in Belgium, Germany, Italy, and Switzerland, a fee-for-service model via country-specific catalogs for specialist services is applied. 

In England, unbundled HRGs are used as a payment mechanism for MRI in outpatient settings. These HRGs are “unbundled” from the core HRGs (used for the primary reason for a patient admission or treatment) and can be paid for each individual HRG in addition to the core HRG. The unbundled HRGs for diagnostic MRI differ depending on the number of diagnostic areas and the injection of contrast agent: for example, in 2025/2026, MRI of one area without contrast is allocated to the HRG RD01A ”Magnetic Resonance Imaging Scan of One Area, without Contrast, 19 years and over” with a tariff of £129, MRI of one area with contrast – to the HRG RD03Z “Magnetic Resonance Imaging Scan of One Area, with Pre- and Post-Contrast” with a tariff of £198, MRI of two or three areas with contrast –  to the HRG RD05Z “Magnetic Resonance Imaging Scan of Two or Three Areas, with Contrast” with a tariff of £222.

Diagnostic MRI can be a subject of specific approaches to reimbursement intended to improve funding for the method and patient access to it. For example, in France, specific technical packages are defined for MRI procedures to cover operating costs, including equipment use, contrast agents, and depreciation. When the MRI equipment is considered fully depreciated, the reimbursement amount is reduced, as depreciation costs are no longer included. The amount of the technical package also varies depending on several factors: the region, the annual number of procedures, and the magnetic field strength of the MRI scanner (in Tesla, T). For example, in Paris, an MRI scanner with a magnet strength between 0.5 T and 1.5 T performing up to 4,000 procedures annually is reimbursed at €194.28 per scan if the equipment is not depreciated, and at €130.54 if it is considered depreciated.

Health technology assessment

Due to established reimbursement in European countries, MRI has rarely been the subject of HTA in recent years. However, novel evidence for established MRI diagnostic procedures can lead to the reassessment of technologies. 

For example, in Germany, the Institute for Quality and Efficiency in Health Care (IQWiG) initiated the evaluation of cardiac MRI in coronary artery disease (CAD) in September 2024. According to the report plan, published in January 2025, the objective of the evaluation is to assess the benefit of diagnostic strategies that include cardiac MRI, focusing on patient-relevant outcomes such as mortality, morbidity, health-related quality of life, adverse effects, and radiation exposure. The evaluation will be based on randomized controlled trials comparing diagnostic strategies with and without cardiac MRI, or, if not feasible, on diagnostic accuracy studies using invasive coronary angiography as the reference standard. The preliminary report with the results is scheduled to be published in the second quarter of 2025.