OIG Analyzes 2014’s Top 25 Laboratory Tests

While laboratories gear up to report payment data now that the Centers for Medicare & Medicaid Services has issued a proposed rule implementing the Protecting Access to Medicare Act (PAMA), the Office of Inspector General (OIG) is fulfilling its oversight role by issuing its annual analysis of the top 25 lab tests based on Medicare payments for 2014. The OIG analyzed claims under the Clinical Laboratory Fee Schedule from independent labs, physician-based labs and outpatient facilities and looked at the claims based on procedure code, beneficiary, lab, setting and test category.

Some highlights from the data OIG reported:

• $7 billion was paid to 63,000 labs under Medicare Part B in 2014 for 451 million lab tests performed for 27 million Medicare beneficiaries.

• Medicare paid $4.2 billion in payments for the top 25 lab tests. Most of the top 25 tests were in chemistry and the most expensive tests molecular pathology tests.

• Over half of Medicare beneficiaries receive at least one lab test in 2014; the average was 17 tests per beneficiary. One percent of beneficiaries received 95 or more tests.

• Lab tests generated approximately 3 percent of total Medicare Part B payments.

• The majority of Medicare payments for the top 25 laboratory tests went to independent labs.

• 63,730 labs received an average of $109,898 in Medicare payments.

• The top three laboratories based on volume performed an aggregate total of 69 million tests billed under Medicare Part B.

• 80 million venipunctures led to $239 million in Medicare payments.

• The top three lab tests according to payment were: Blood test for thyroid-stimulating hormone, Blood test for a group of blood chemicals, and Complete blood cell count automated test.

• 13 of the top 25 lab tests by payment totals were chemistry tests which yielded $2 billion in 2014.

The OIG’s report, “Medicare Payments for Clinical Laboratory Tests in 2014: Baseline Data” is available on the OIG website.