OIG Report for Lab Spending 2024 Omits "81479" As Line Item

Header:  OIG Report on 2024 Lab Spending Omits 81479, the Biggest MoPath Code

In January, the OIG released a required annual report about year-to-year changes in laboratory test spending at Medicare - entry point here.  The annual report helps Congress monitor the impact of major CLFS payment changes legislated in 2014 for 2018 and later.

• In the past, OIG included the molecular nonspecific code 81479 as a top spend code.  
• This year, the new report (the report about 2024) omits 81479 as a specific liine-item code.    
• (I assume they must have included it in the total sum of spending, though.)

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Here I compare top codes in the lab industry in the Fall release of 2024 data, and the OIG analysis just published.  The OIG analysis includes hospital labs, but since nearly all of the top codes are proprietary, they are not billed by general hospitals.   

The one code that could be billed by hospitals, 87798, other pathogen, had very little billing by hospitals (in table below, it's $442M minus $437M, or $5M or about 1% of 87798 was billed by hospitals, and 99% by a few private labs in Florida and Texas.)  

Another dubious code, 81419, epilepsy panel, was only billed by labs in Florid and Texas in Part B data, and OIG's data confirms that 0% of the 81419 billing was from the nation's hospital genetic labs.

Reminder - Among Non Proprietary codes in 2024 SEVERAL were dubious

First, here's what I got in fall 2025 for CY2024, looking within the data set of 812nn 813nn 814nn 815nn.(omitting PLA codes and omitting Microbio codes, which include giant code 87798).

For the moment ignoring 87798 and PLA, 81479 was 42% of spending - nearly half - of genomic codes.

Of the other 7 codes shown above, 3 are flaky as hell - 81419 epilepsy, 81440 mitochrondria, and 81443 - rare inherited conditions.

In its table of top-25 lab industry codes, OIG only gets one of these non proprietary genetic codes, 81419, where OIG reported $73M billing in hospitals and independent labs together, whereas I reported $73M billing from independent labs alone (thus we infer 0% from hospitals).

So we knew last fall dubious codes seemed to be billed only by labs in Texas and Florida.  If we add in nationwide hospital billing, as OIG does, it adds only negligibly or not at all to the dollar volume.

Lab-Level Spending on 81479 Would Have Rated a Row in OIG Report

If you look at dollar intake from 81479 from large labs, had they been viewed as "a test," some would have met the $50M threshold to be a top code in the OIG Report which goes down to about $70M.  (2023 data below).

81479 Was Omitted from 2024 OIG Report (Jan 2026); Here, 2023 Data