On December 20, 2024, the OIG released its mandatory annual report on CMS spending on the Clinical Laboratory Fee Schedule. The report is required by the PAMA legislation of 2014.
Find the report here:
The 12-page report is useful because it includes hospital outpatient lab tests, as well as Part B CLFS tests. (Many CMS Part B reesources don't include hospital lab tests.) For the year-on-year analysis, OIG found that COVID spending fell from $1.7B in 2022 to $751M in 2023, a 56% decrease and a drop of nearly $1B.
In addition, by 2023, CMS had finally closed town the explosion of spending on sequencing code 81408, a $2000 nonspecific sequencing test that had colossal payments with no controls for a while at the Novitas and FCSO MACs (esp. 2019, 2020.) Genetic spending fell from $1.9B in 2021 to $1.4B in 2022. (They define "genetics" broadly, e.g., Cologuard).
Kvetch - Why not upload a link for full data?
OIG publishes a data table (page 7) of the top 25 tests by dollar spend. Only a few of the top 25 are genetic tests. For my money, since OIG has the data, it could ALSO simply post a link to the entire spreadsheet (>1000 tests) for the public. It would cost OIG nothing and cost the public nothing.
Top 25
click to enlarge |
The top genetic test (#4 of all tests) is 81528, Cologuard, $508, voume up 13%, spend $301M.
The next genetic test (#9) is 81455, >50 tumor genes, uup 59%, $145M. (I believe this code is only used outside of MolDx states).
The next genetic test (#14) (55-74 genes, Guardant CDx) is0242U, $5000, up 31% YonY, $105M.
The fourth genetic test (#17) is Oncotype Dx, 81519, $3873, up 2%, at $95M.