Wednesday, September 1, 2021

Use of the PLA Codes in CY2019 - Who Got Paid for Them?

In a previous blog, I noted that on August 31, 2019, CMS released data for CY2019 utilization by physician or lab and by CPT code.

I searched the data for all codes containing "U" - PLA codes.  129 entities billed for PLA codes.  Total payments under PLA codes were $115M.   

Use of PLA codes was HIGHLY concentrated.  Foundation Medicine had $78M for 0037U, the Foundation Medicine FDA test (used 22,954 times).   That's almost 70% of all PLA code use from ONE code in ONE lab.

Next up was Genomic Health with $21M for 0047U and $2M for 0045U - that's Genomic Health Prostate and Genomic Health DCIS, respectively.  Those three codes so far were 88% of all use of PLA codes.  When someone was paid for a PLA code, about 70% of the time it was less than $100K.

I've put a cloud spreadsheet here.  

I've clipped the top lines of the database below. Click to enlarge.