I covered previous editions of these reports in a September 12, 2017 blog, here.
Around October 1, 2017, OIG issued its third annual update on spending on the CLFS, focusing on the top 25 tests, updated with CY2016 data - here. The 10 page PDF shows that the OIG has already had access to 2016 data.
- In November 2017, the public will be able to see CY2016 Part B data for all CPT codes at the nationwide and the state-level.
- In about June 2018, the public will be able to see CY2016 Part B data right down to the individual provider & CPT code level.
- For details, here.
While, of 58,593 labs, the average payment was $115,546, half of labs received less than $1,055. Hospital labs were 26% of Part B payments and physician office labs were 18%. 1% of labs garnered 54% of payments.
The top 6 lab tests were $2.4B (out of $6.8B); the top 25 were $4.3B. The highest-paid test was again TSH (84443, $22.89 per test, $482M total). Two genomic tests made the top 25, being Cologuard at $62M, and Oncotype Dx at $60M. They state there was a 2015-2016 drop in molecular pathology testing e.g. germline genetic tests (which they class differently from MAAA tests), from $260M to $165M. We'll know more about which codes were involved when CMS released CY2016 for public view in November 2017.