Thursday, May 25, 2023

Welcome to the Madhouse: CardioDx Long Gone, but Novitas Continues Millions in Annual Payments

Recently, someone had me look at CPT code 81493, which represents solely the CardioDx CorusCAD test ($1050).  The company went bankrupt and closed in 2019 after Moldx withdrew coverage.  Prior to Medicare cancelling the CorusCAD test coverage, annual payments were substantial ($30M in 2018, a top-ten test).  The April 2023 coverage listing from Florida BCBS lists 81493 as experimental.

The proprietary, single-lab CPT code is still alive, and as of 2023, the AMA shows the code as being still registered to CardioDx.  AMA writes that the PLA MAAA tests are "unique to a single laboratory," the laboratory here, for AMA, for the year 2023, is CardioDx.  

Payments continue only from the Novitas MAC and only to a few labs in Texas.  This suggests the test may be re-licensed as an asset, but, the AMA still shows it as the first owner, CardioDx.  Novitas's 2020 payments for the test were $2M; Novitas's 2021 payments were $1.6M, or a two-year total of $3.6M.  

2021 payments were divided among 3 labs; one was a high biller of code 81408 (rare, full-sequence genes), another got half its revenue from 81493.

Novitas' current billing article A58917 specifically lists 81493 as Category I, payable. And a future update of the same article at FCSO (A58918) continues the coverage.   MolD's negative LCD, which killed the company in 2019, was retired in late 2022 (L37770).  


Coverage began in 2012.