Very Brief Blog: OIG Releases 4th Annual CMS Lab Payments Report

PAMA created a new pricing system for CMS labs in 2014, and also a requirement for annual OIG reports.   OIG has issued its fourth annual report, covering both Part B independent lab payments and also Hospital Outpatient Reference Lab payments, for CY2017, in September 2017.

• See the OIG 4th Annual Report here.
• Appendix A provides links to prior OIG reports.
• See coverage at 360DX here.

1% of labs received 55% of Medicare payments for the top 25 tests.

In this blog, I summarized data from Part B CY2017, and also provided links to the CMS spreadsheets.  My article focuses on the top 10 molecular codes.  That article is here.

By code, the highest paid codes were 84443 (TSH), $484M, blood panel 80053, $473M, CBC 85025, $432M, lipds 80061, $415M, and Vitamin D 82306, $348M.   Next up were 22 or more drug tests, G0483, $307M, and A1c 83036, $257M.  The highest molecular test, Cologuard, 81528, came in #12 overall at $117M.

Comparing data from the 2017 CMS spreadsheets for regular Part B independent labs and the OIG summary data (which includes hospital reference labs) allows the hospital lab billing to be imputed at least for the top 25 codes for which OIG provides data.

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The OIG report provides summary data only on the top 25 CPT codes.  Obviously, they could easily provide a cloud link to a table or spreadsheet with all the codes.  

Per the report's Exhibit 2, 1% of labs got 55% of payments; 5% of labs got 79% of payments.  The remaining 95% of labs got 21% of payments.