The PAMA legislation of 2014 requires OIG to issue an annual report on lab spending - in part to show Congress the impact that the new "triennial market price reset" was having on lab spending. As Medicare nerds know, the reset occurred only once (in 2018) based on data from 2016.
The lab report suggests that the increase in genomic tests was due to spending on cancer, infections, and epilepsy. The growth in cancer spending was national, and included MolDx states with big-name cancer genomics labs. The growth in infectious and epilepsy was more dubious, occuring only Novitas states and mostly due to an nonspecific PCR code for pathogens (87798), the highest cost line item at $442M. Epilepsy - a panel used only in non-NGS MAC and non-MolDx states - 81419 came in at $73M.
So for a few years Novitas had about the highest-paid code 81408 rare gene (sic) full length sequencing, circa $500M, and that fell to zero at the same time as 87798, uncontrolled pathogen code, role to circa $500M. Sigh. Payments outside Novitas hot spots like Texas and Florida was very small, and billing for 87798 and 81419 by known labs (whether Quest-LabCorp type or GeneDx-Ambry type) was about nil.
Get the full report here:
https://oig.hhs.gov/documents/evaluation/11453/OEI-09-25-00330.pdf
