Wednesday, November 9, 2022

2021 Category III Codes: Extreme Concentration of Usage Continues

Around November 1, CMS released Part B utilization by CPT code for CY2021, here.  I primarily discussed MoPath utilization.  I did a supplemental blog on ADLT utilization here.  

In this blog, I do my annual analysis of Category III or "T" codes.  CMS lists 260 active Cat III codes for CY2021.  Total payments for 2021 were $185M, but highly concentrated.

Only the top 30 had more than $100K in utilization.   Only codes in the top 75 had more than $10,000 in utilization.  Just about half had $1000 or less in utilization, many of those being "0".

The top 11 codes had more than $1M in payments, of which 5 or about half were related to ophthalmology.  The top code, 0191T, an anterior segment ocular procedure, had $122M in payments or 66% of all payments for all of the 260 Category III codes.

The top 4 codes had 85% of payments, for the 260 codes.  As to pricing per use, about half of the top 11 codes paid more than $1000 per use.

Click to enlarge.

0055T (the bottom code) is a bizarrely over-aged Cat III code and somehow remained Cat III even with years of use and >8000 uses per year (in Medicare).  For CY2023, the oldest codes are 0042T and 0054T, 0055T.