Header: OIG Releases Report on 2024 Lab Spending.
What it is.
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.
My blog September 2025.
CMS released most of this data in September 2025, and I reviewed and discussed it then. Blog.
Genomeweb Discusses OIG.
Genomeweb/360Dx (Adam Bonislawski) covers the OIG report, and also has a long discussion of the weirder aspects of molecular spending.
What OIG found.
The report has extensive tables and graphics focused on genomic vs conventional lab spending.
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 81419 - 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
The highest paid genomic code, 87798, nonspecific pathogen, was $442M, much of it "odd."