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.
Breaking out 81479, "Code #1," these were top-paid labs:
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.
Some More Examples from the Data:
87798
87798 was a very widely used code in 2019-2020-2021, including in MolDx states. Then MolDx brought out an LCD, or revised one, that made it very hard to use 87798 (other molecular probe, pathogen). The top 20 labs biling 87798 by 2023 were almost all in non-MolDx states.
MolDx vs Other MACs on 81455 (81456)
