The 30 MolDx states have LCDs that generally, make it hard to bill for panels of >5 pathogens (with some rules and exceptions), and that, generally, make it hard to bill for urine pathogens using large molecular panels.
CMS recently released CY2024 national Part B payments for 87798, "other pathogen, amplified probe."
Of around $450M in payments, about 90% went to labs and 10% went to clinicians ($49.3M paid to pathologists (by individual's name, not "laboratory") or to other clinicians (e.g. urologists).) A urologist in the midwest garnered over $1M for 87798 billings alone; a urologist in mid-Atlantic, $650,000. The midwest urologist had $2.7M in Part B payments, of which $1.7M from lab tests (codes 8nnnn). He had about 3300 office visits (63/wk x 52 weeks.)
In total, tallying up code 87798 clinician payments from 2024, these went to 396 urologists, 117 nurse practitioners, 87 podiatrists, 70 physician assistants, and 52 pathologists. (With few exceptions, 87798 payments over $1M per year, went to pathologists).
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