Wednesday, September 1, 2021

Use of Genomic Code 81479 in CY2019 - Who Got Paid for It?

In a prior blog, I noted that CMS has just released data by provider (physician or lab) and CPT code for CY2019.  I also discussed usage of the largest code in genomics, 81408, billed only by labs in the Novitas and FCSO jurisdiction.

In this blog, I provide a link to a cloud excel file of labs billing CMS for molecular unlisted code 81479 in CY2019.  Virtually all the billing of 81479 (96%) was in MolDx states.  The other 20-some states had almost no payments at all under 81479 (almost zero).  

Total 81479 allowed charges were $197M, of which 59% was paid in California.

The cloud data file is here. A summary by states is in the table below.