There was $1.6B in Part B Medicare spending for Molecular Pathology in CY2019. Hundreds of millions of dollars were fraudulent.
Among the normal spending, the #3 molecular pathology code with some $200M of claims, was Unlisted Code (Miscellaneous Code) 81479.
In some states, this code was over 90% of spending, and 95% of all use of code 81479 was in MolDx states. Data below.
In a previous blog, I discussed 2019 Medicare Part B molecular pathology spending, highlighting several trends including explosive growth in fraudulent spending, where and under what codes. Here.
In this blog, we take a deep dive on spending under the MoPath Unlisted Code, 81479. I collated data from the 50 state spreadsheets and found it summed correctly up to data in the single US national Part B spreadsheet. All data shown use "dollars allowed." (Since MoPath doesn't have copays, this is similar to actual Medicare program dollars spent.)
US Part B MoPath spending was $1,690,000,000 in CY2019. Of this, $202,933,000 was coded as 81479, Unlisted MoPath code. 12% of all MoPath spending flowed through 81479, and 81479 was the #3 MoPath code in terms of dollar volume.
Nearly all spending under 81479 was in the MolDx states.
MolDx states spending $192,480,664 on 81479, and non-MolDx states (about half the US) spent $9,452,177 on 81479. (Services were 103,263 and 5,164 respectively. Spending per single service was about the same in MolDx and non-MolDx states ($1,864; $1,684).
Per state, the highest percentage spend on 81479 was 96% for Ohio (15% of US total 81479).
Arizona was next, with 52% of molecular pathology spending there, under 81479 (16% of US total). California was next, with 33% of state spending on MoPath being 81479, and 64% of all US 81479 spending flowed into California.
The highest non-MolDx state for 81479 spending was Pennsylvania, with 4% of the US 81479 total, and 12% of Pennsylvania MoPath dollars flowed through code 81479. No other non-MolDx state contributed 81479 spending above data dust, since 4% of 81479 went through Pennsylvania, then 95% through MolDx states.
All the data I've quoted is in the table below (click to enlarge).
It's not an Excel artwork but I've put the underlying data worksheet in the cloud here.
2019 MoPath spending was $1.7B, all Lab/Path spending was $7.3B, so MoPath was 24% of all lab spending, a far higher percentage than ever before.
I don't know who Novitas/Pennsylvania spent the 4% or $8M on. However, in CY2017, Novitas/Pennsylvania 81479 spending went to only 3 labs, with 95% or $3.2M going to Interpace for 1,839 "81479" services at $2304 allowed each.