Friday, September 23, 2016

Medicare's Use of MoPath CPT Codes in CY2014

Earlier this year, CMS released CY2014 data on the use of all CPT codes in Medicare Part B (here).  This data includes extensive provider look-up tables.   (The actual CPT code aggregated data is similar to that released in 11/2015 for CY2014, but the full data sets are more comprehensive by state, or by lab, or by physician, etc.   The full dataset is 1.9GB and needs to be handled by special database software, but the data is open access).

In an excel spreadsheet in the cloud, I've pulled the molecular pathology codes.  They are sorted three ways:  (1) by volume of services per code, (2) by dollars paid by Medicare per code, and (3) a separate table only for Tier 2 codes.   In the cloud, here.  (Download by clicking the small down arrow, upper right in most views).

For screen shots, see larger view by clicking on the images below.
  • By volume, the Tier 2 code 81401 leads, with 422,556 services, while seven codes had >200,000 services and then the usage dropped suddenly to <60,000.  80% of codes had less than 10,000 uses by CMS, half had less than 1000 uses by CMS.  One-third of the codes shown were paid by CMS at least once, but less than 100 times.
  • By dollars, in 2014, two Cyp genes led in Medicare payments, with $273M in total payments or about 50% of all CMS molecular payments.   75% of codes listed had 2% of CMS dollar payments.
  • Among Tier 2 codes, 81401/Level 2, dwarfs all other Tier 2 codes, with about 80% of Tier 2 utilization and $46M paid or about $110 per CMS claim.  Only 2 providers submitted any Level 3 codes, with a total of just 17 tests paid and grand total of $4,700.

(More after the break).

Again, for full views, download spreadsheet from the link near the top of this blog.