CMS Posts Cy2025 Part B National Utilization Data

 CMS has posted CY 2025 National Part B utilization data as simple Excel files.  Find them here:

https://www.cms.gov/data-research/statistics-trends-and-reports/part-b-national-summary-data-file?

For example, allowed dollars for code 81479 are up to $512M (for 205,000 services).

The same data will be posted in vastly more detailed sometime around June 2027, sortable for every physician and lab using each CPT code (here).

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Here's our analysis of the CY2024 data as written up in 9/2025.

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For 2025, PLA codes totaled about $1.5B, with almost half going to the top 3 codes.  The top 20 PLA codes had 90% of PLA dollars.

(See brand key below).

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For mainstream codes 81162 to 81599, there were $1.9B in payments, from which 27% or $512M going to 81479, unlisted code, used almost entirely at MolDx.

The top 20 mainstream codes had 80% of the dollars in this category.

87798

87798 (other pathogen) rapidly rose to be the highest Medicare molecular code, shooting skyward even as prior supercode 81508 ($2000, Level 9) dropped off the chart.   

• In 2024, 87798 was 12.7M services for $447M.
• In 2025, 87798 was 12.3M services for $430M.
• We hear that in 2026, at least by late spring, payments for 87798 had slowed to a trickle. 

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CODE NAMES - PLA

0464U, Exact Sciences, Cologuard Plus
0211U, Caris Life Sciences, MI Cancer Seek – NGS Analysis
0340U, Natera, Signatera
0326U, Guardant Health, Guardant360
0540U, CareDx, AlloSure
0242U, Guardant Health, Guardant360 CDx
0108U, Castle Biosciences/Cernostics, TissueCypher Barrett’s Esophagus Assay
0037U, Foundation Medicine, FoundationOne CDx
0537U, Guardant Health, Shield
0473U, Tempus AI, xT CDx
0345U, Myriad Genetics/Assurex Health, GeneSight Psychotropic
0485U, Caris Life Sciences, Caris Assure
0239U, Foundation Medicine, FoundationOne Liquid CDx
0315U, Castle Biosciences, DecisionDx-SCC
0026U, CBLPath/UPMC, ThyroSeq v3 Genomic Classifier
0080U, Biodesix, BDX-XL2
0047U, MDxHealth, Genomic Prostate Score (GPS) Test
0241U, Cepheid, Xpert Xpress SARS-CoV-2/Flu/RSV—All Targets [deleted code]
0356U, Naveris, NavDx 

CODE NAMES - 80,000 series

81479, Unlisted molecular pathology procedure
81542, Veracyte, Decipher Prostate
81528, Exact Sciences, Cologuard
81519, Exact Sciences/Genomic Health, Oncotype DX Breast Recurrence Score
81529, Castle Biosciences, DecisionDx-Melanoma
81456, Tumor or hematolymphoid neoplasm, RNA panel, 51 or more genes
81464, Solid-tumor liquid biopsy, comprehensive DNA/RNA genomic profiling
81419, Epilepsy genomic sequencing panel
81440, Nuclear-encoded mitochondrial-disorder panel, 100 or more genes
81459, Solid tumor, comprehensive DNA/RNA genomic profiling
81443, Severe inherited-disorder panel, 15 or more genes
81546, Veracyte, Afirma Genomic Sequencing Classifier
81518, Hologic/Biotheranostics, Breast Cancer Index
81455, Tumor or hematolymphoid neoplasm, DNA panel, 51 or more genes
81541, Myriad Genetics, Prolaris
81595, CareDx, AlloMap Heart
81307, PALB2 full-gene sequencing
81418, Pharmacogenomic panel, 6 or more genes
81249, G6PD full-gene sequencing
81238, F9 full-gene sequencing