Tuesday, June 20, 2017

Brief Blog: Does MOLDX Manage 87% of US Medicare Molecular Pathology?

A few days ago, CMS released provider-specific and CPT-code payment files for CY2015.   See the initial blog here, which includes a targeted analysis of Medicare spending via unlisted code 81479 (here).    Later, we provided a brief overview of Medicare spending by several key categories (here).

Today's analysis sorts each state by Medicare mopath spending (codes 812xx 813xx 814xx 815xx) - and then aggregates states by MAC and by whether the MAC is part of MolDx.

If our analysis is correct, 87% percent of US Part B MoPath codes pass through MolDX states and policies.   More after the break.


Most of this cash flow from Medicare to labs is via Noridian, with the lead states of California and Utah.  See the following table; click to enlarge:


We also provide data sorted by state for the top 21 states, which cover 99% of payments (click to enlarge):


For MolDX, in round numbers, of $480M total:  there's almost $275M in California, another $50M in Utah and almost $25M in Ohio.  Then add in $35M for Hawaii and Washington State.   That sews it up.

The excel spreadsheet is in the cloud, here.  In the cloud, see several tabs at the bottom of the webpage and see the local-download arrow at the top right.

Disclaimer.  These calculations included quite a bit of sorting and filtering and block-addition by hand; it's correct to the best of my knowledge.