Earlier I posted that on August 31, 2021, CMS released CY2019 utilization data by provider (or lab or IDTF), and by CPT code.
Here, I culled the data for all Category III codes (searched as all codes containing "T.")
There were 11,000 unique lines where a provider was paid for a Category III code. Total payments were about $240M.
The largest was iRhythm, paid $57M for code 0297T, followed by Cardionet, paid $8.9M for 0297T. While the 3rd-largest line was code 0379T at $4M (remote visual field assessment), the 4th and 5th lines were again 0297T, about about $3M each. Thus, by line five, 31% of all Cat III payments were accounted for, and most were for cardiac patch-based monitoring, 0297T.
After that, the next ten or fifteen top payments went to code 0191T, an ophthalmic surgery code (anterior chamber drainage device).
See my extracted cloud database here. I've sorted one page by "dollars" and one page by "CPT code" in order.
|click to enlarge|
That's penny billing for Cat III codes. I went back to the CMS data source and searched paid claims for one penny services. About 90 CPT codes received payments (for some docs) of one penny, totalling 25,000 payments of one penny. 0296T, the main T code on the list, is not even very high up at #741 payments of one penny. J7613, albuterol, inhalation, had 2803 payments of one penny, and g0444, annual depression screening, had 2553 payments of one penny. Ipratropium inhalation J7644 and denosumab injection J0897, had 1986 and 1506 payments of one penny, respectively. The 90 CPT codes getting 25,000 payments of one penny were distributed across some 700 docs.