Thursday, July 27, 2017

Brief Blog: Medicare Payments for Quantitative Immunohistochemistry (88360, 88361)

AMA CPT provides two codes for quantitative immunohistochemistry, 88360 for manual, and 88361 for computer-assisted.

How common is their use?  We used the 2015 Part B Provider Database online at CMS.  Data after the break.

  • For the two codes together, 88360-88361
    • Medicare paid $38M for 448,000 services to 162,000 beneficiaries.
      • There may be some double counting if the technical and interpretative component were submitted separately; the database only recognizes the code and not the TC (technical)  or -26 (interpretation) modifiers.
    • The rate average 2.75 slides per beneficiary.
    • The highest paid provider had $5.9M (15% of all services for both codes, and on 88361 only.)  
    • 9 providers had >$200,000 of billings, together billing 35% of all services.
    • For 88360, there were 3,495 total providers, for 88361, there were 914 total providers.
  • For 88360
    • Medicare paid $24M for 309,000 services to 122,000 beneficiaries.
    • The rate average was 2.5 per patient.
    • The top 4 providers, provided 13% of all services.
    • 15 providers billed over $100,000, the highest being $2.5M (in Baco Raton, FL)
  • For 88361
    • Medicare paid $15M for 139,000 services for 40,000 beneficiaries.
    • The average rate was 3.5 per patient.
    • The top 4 providers provided 20% of all services.
    • 8 providers billed over $100,000, the highest $5.9M (in Airmont, NY)
  • Across both codes but totaling each code separately, just 10 providers billed at a rate of 7 or more slides per patient.  
    • Most of these were providers doing only 100-200 services per year.   

I looked briefly at in-situ hybridization, which has a large number of codes for first specimen, additional ISH, multiplex, etc.  Medicare paid $41M for ISH, with 358,000 services for 173,000 beneficiaries.  The highest paid provider netted $6.6M (for 88377 alone) and the top 10 providers provided 45% of all services.  

Regarding "rate," the busiest provider on a per patient basis provided 1179 services of 88374 to 32 patients, or about 35 per patient.  However, he did only $4,500 of Medicare's total of $40M in services.

About 20 providers gave >6 ISH services per patient, but they were all small volume providers.  One provider gave $1.6M of ISH services to about 2000 patients or 4.5 per patient.