Wednesday, October 4, 2017

Brief Blog: OIG Issues Report on CY2016 CLFS Spending at Medicare

PAMA law requires the OIG to issue updates on payments for Medicare's top 25 lab tests, as well as reports on CMS's progress in implementing PAMA itself by creating new fee schedules.

I covered previous editions of these reports in a September 12, 2017 blog, here.

Around October 1, 2017, OIG issued its third annual update on spending on the CLFS, focusing on the top 25 tests, updated with CY2016 data - here.   The 10 page PDF shows that the OIG has already had access to 2016 data. 
  • In November 2017, the public will be able to see CY2016 Part B data for all CPT codes at the nationwide and the state-level.  
  • In about June 2018, the public will be able to see CY2016 Part B data right down to the individual provider & CPT code level.  
    • For details, here.  
In CY2016, CLFS payments were $6.8B, or about 2% of Medicare Part B payments.   This $6.8B is a bit less than the $7.0B logged in CY2015 and CY2014.  There were 473M test payments under 1,173 CPT codes.

While, of 58,593 labs, the average payment was $115,546, half of labs received less than $1,055.  Hospital labs were 26% of Part B payments and physician office labs were 18%.   1% of labs garnered 54% of payments.

The top 6 lab tests were $2.4B (out of $6.8B); the top 25 were $4.3B.   The highest-paid test was again TSH (84443, $22.89 per test, $482M total).  Two genomic tests made the top 25, being Cologuard at $62M, and Oncotype Dx at $60M.   They state there was a 2015-2016 drop in molecular pathology testing e.g. germline genetic tests (which they class differently from MAAA tests), from $260M to $165M.   We'll know more about which codes were involved when CMS released CY2016 for public view in November 2017.