A few weeks ago, CMS released state and national level data on Medicare Part B spending by CPT code for CY2019.
I ran an analysis on MoPath spending and found that 81408 - the Tier 2, Level 9 CPT code for rare fully sequenced genes - had exploded from 2017 to 2018 to 2019. This explosion was concurrent with DOJ fraud cases alleging billions of dollars in fraudulent MoPath charges. See an entry point here for the DOJ story and links therein. See my original article on CY2019 Medicare data here.
From previous blogs in this series, chiefly here, we knew that 81408 spending exploded from almost nothing in 2017 to 2018 to 2019. It rose from nowhere to be the highest paid CPT code in MoPath in 2019. See figure:
Before the Deluge: 2017 Spending on 81408
2017 81408 spending was small ($9M). But when you look at it, it was already very atypical - all billed in two states that had little share of the national mopath billing, but had a monopoly on the 81408 billing.
We know from the 2017 CMS physician/lab utilization data that only 9 entities nationwide were paid in 2017 for 81408 billing. All labs receiving payments for 81408 in 2017 were in the now-defunct Cahaba MAC.
Remarkably, Oklahoma had the highest payments for 81408, totaling half to that state's mopath spending (much of the rest was BRCA 81162, another easily-paid code that's also nearly $2000 per test).
81408 is non covered by United Healthcare, here.