In a previous blog, I noted that CMS had released CY2023 Part B claims (by doctor or by lab) for CY2023. I showed the top ten billing labs for 81479, molecular unlisted code, for which the total dollar volume was nearly half a billion dollars ($488M) in 2023.
Here, I went back to the cloud database and extracted all the molecular codes (811 series to 815 series), plus PLA codes ending in U, plus microbiology molecular codes (87468-87999).
The database has 130,000 lines, and weighs about 30 MB after I had done some different sorting options.
Total molecular dollar volume in 2023 was $3.4B, of which 14% or $488M went to 81479.
After that, $300M or 9% went to 81528 (Cologuard / Exact Sciences) and $288M or 8% to 87798 (other infectious agent probe). The next two positions were 3% for $118M for 81455 (any lab, heme CGP) and 3% $104M to 0242U Guardant FDA LBx CGP test.
The top 15 codes had 57% of all dollar volume. Click to enlarge.
PLA CODES
CMS logged sales for 82 of the approximately 400 PLA codes at the time. Total sales for PLA codes were $519M. The top 10 PLA codes got 80% of the PLA code dollar volume (of all 400 PLA codes). The top 4 PLA codes (or 400 PLA codes) had half the dollar volume. Click to enlarge.
About half the PLA codes, that logged any Part B sales, logged less than $100,000. About a quarter of the PLA codes, that logged any Part B sales, logged less than $10,000. About 3/4 of the 400 PLA codes for 2023 logged 0 sales at CMS.
See It Yourself
I posted the 30 mb Excel file as a Cloud resource in Google Drive. It's open access but you may need a google account to see and download it.
