Thursday, May 25, 2023

Welcome to the Madhouse: CardioDx Long Gone, but Novitas Continues MILLIONS in Annual Payments

Recently, someone had me look at CPT code 81493, which represents solely the CardioDx CorusCAD test ($1050).  The company went bankrupt and closed in 2019 after Moldx withdrew coverage.  Prior to cancelling the coverage, annual payments were substantial ($30M in 2018, a top-ten test).

The proprietary, single-lab CPT code is still alive, perhaps because no one owns it, to delete it.  

And gosh, payments continue at a surprising rate, but only from the Novitas MAC and only to a few labs in Texas.  Novitas's 2020 payments for the already-dead test were $2M; Novitas's 2021 payments were $1.6M, or a two-year total of $3.6M.  

2021 payments were divided among 3 labs; one was a high biller of code 81408 (rare, full-sequence genes), another got half its revenue from 81493.

Novitas' current billing article A58917 specifically lists 81493 as Category I, payable. And a future update of the same article at FCSO (A58918) continues the coverage.   MolD's negative LCD, which killed the company in 2019, was retired in late 2022 (L37770).  

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Coverage began in 2012.