CMS also provides ALL the raw data in an open access web interface that allows filtering and data pulls. The data website is here.
(This is the same data I have reported on and used for physician and lab Medicare Part B claims, e.g. here. I have some instructions for using the Part B data set, here; the PAMA dataset is nearly the same so the Part B instructions will help understand the PAMA web interface.)Between Medicare 2015 Part B claims data on line, and the new PAMA data for 1H2016, anyone can have an unprecedented view of the US lab industry - for free.
Imputing National Volume Data from CMS Part B Public Data and New PAMA Public Data
For example, we already knew that in CY2015 data from CMS, there were about 19,000 uses of BRCA full sequencing under code 81211 (here).
I made a simple data dump of the new 1H2016 PAMA private payer data for BRCA and stored in the cloud here. It shows 94,977 uses of 81211 paid by private payers. (Remember, that's for 1H2016, a half year).
This suggests that if we add CMS Part B 2015 data (19,000 uses) and we "double" the PAMA 1H2016 data to account for a full year (190,000 uses), there are about 219,000 uses of BRCA sequencing 81211 per year, and Medicare cases are about 10% of the annual total of BRCA sequencing cases.
Wild West of Price Ranges
You also see bizarre stuff. For example, the table reports 22 payments for BRCA sequencing 81211 at $44,207. And 27 payments at $30,969. And 28 payments at $17,612. But PAMA data also shows dozens of paid claims for 81211 trickling in at the triple digits ($150, $149, $145).
The density distribution of BRCA 81211 price points is non-normal (non-Guassian):
You don't see this detailed price distribution data for sole-source labs. For example, if you filter the raw data for 81519, Oncotype DX Breast, you don't get any of the raw data - neither volumes nor prices.
Nonetheless, in the PAMA zip file of data, CMS does provide summary statistics such as 25th percentile and 75th percentile for all tests, including sole source proprietary tests.
For Oncotype DX 81519, this file shows a 2017 current Medicare price of $3443, with PAMA new weighted median of $3873, and a 25th/75th percentile range of ($3713, $4153), which is pretty tight. However, CMS also tells us the minimum reported payment for 81519 was $1 and the maximum was $38,632 (click to enlarge):
Wild World of Clinical Chemistry Price Ranges
The spread and strangeness isn't limited to genetics. I checked a routine clinical chemistry code, 86003 (blood-based IgE allergy testing) and while the PAMA price will eventually fall to around $4.50 from the current around $7, there were dozens of PAMA reported payments exceeding $500 per test, and even exceeding $1000.