On May 21, 2026, CMS released data by lab and by CPT code (also by physician and CPT code) for Part B payments in CY2024.
There's been a lot of discussion of changing payment policies for code 87798 in the past six months; 87798 can be use as a "probe" of the data set.
Find more about the data set here:
https://www.discoveriesinhealthpolicy.com/2026/06/cms-releases-rich-cloud-database-for.html
87798
First, we searched the dataset for all providers billing 87798. There were about 1400 total providers of 87798 services. Payments per provider ranged from $24M down to $109. Total payments for 87798 in all 50 states were $436,743,071. $436M. Of that $436M, $139M or 32% went to TX and $36M to PA, $34M to FL, $23M to NJ. This shows strong representation of Novitas and FCSO states for 87798 payments in CY2024.
Among all codes, 87798 was $436M, 81528 Exact Cologard was $306M, and 81479 was $572M (prior blog).
Services per bene - about 20 labs billed >30 services per year per bene, including 3 that billed >60 services per year per bene (87798).
The top providers of 87798 received $24M, $21M, $12M and $8M.
Note that this is only about 16% of all 87798 payments. Services per patient per year ran from 9 to 20. The four labs were in TX (2 labs) and PA and FL.
Top Four Labs Billing 87798: Their Overall Billings
We used these four labs to go back to the database and get all the CMS payments to these labs.
The four labs are the "new universe" of claims. The four labs were paid $131M in total, and got half of their Part B revenue from 87798 ($65M).
After getting 50% of revenue from 87798, they got 12% for candida amp probe (87481), 4% for 3-5 Resp Virus panel (87631), and about 4% each for Strep B Amp Probe (87653) and MultiOrg Amp Probe (87801). These five tests brought in about 74% of all the annual revenue of the 4 labs.
Special Mention to Moldx Labs
Although it's not a big lab, I feel like honorable mention should go to MolDx Labs, in North Hollywood CA, which was paid $2.7M in 2024 by Noridian and MolDx, 58% for large panels of code 87798. Look up the NPI - from March 2024 - it's really "MolDx Labs."
