OIG Reports that 2018 Medicare Part B Lab Test Spending Increased Despite PAMA Cuts
It wasn’t supposed to happen like this. The expectation was that the new PAMA market-based pricing system was going to save Medicare 10 percent or more on lab test reimbursements. But it hasn’t happened, at least not in 2018, the first year under the PAMA scheme. That’s the surprising conclusion of a new OIG report finding that Medicare Part B spending on lab spending actually increased during the year. The OIG’s Findings As the PAMA law requires, the OIG analyzed 2018 claims data for tests reimbursed under the Part B Clinical Laboratory Fee Schedule (CLFS) in comparison to 2017 CLFS spending. Results: Even though 75 percent of the tests were subject to the PAMA fee cuts, Medicare spending on CLFS lab testing increased $459 million, from $7.1 billion in 2017 to $7.6 billion in 2018. In other words, the rate cuts weren’t enough to offset the increased spending for other tests. The OIG pinpoints two forms of tests as being responsible for the increase. Genetic Tests Medicare spending on genetic tests went from $473 million to $969 million as a result of higher utilization and the addition of new and expensive tests to the CLFS. Spending on genetic tests increased […]
Test Description (Procedure Code) | 2017 Fee Sched Rate | 2018 Fee Sched Rate | 2018 Test Volume (Millions) | 2018 Medicare Spending (Millions) | Change from 2017 Spending (Millions) |
Blood test, comprehensive group of blood chemicals (80053) | $14.49 | $13.04 | 41.64 | $537.10 | +$64.37 |
Blood test, lipids (cholesterol and triglycerides) (80061) | $18.37 | $16.53 | 28.58 | $463.58 | +$48.66 |
Blood test, thyroid stimulating hormone (TSH) (84443) | $23.05 | $20.75 | 21.39 | $434.71 | -$49.26 |
Complete blood cell count (red cells, white blood cell, platelets), automated test (85025) | $10.66 | $9.59 | 41.14 | $391.09 | -$41.09 |
Vitamin D-3 level (82306) | $40.61 | $36.55 | 8.94 | $318.95 | -$28.97 |
Drug test(s), definitive, 22 or more drug class(es), including metabolite(s) if performed (G0483) | $253.87 | $246.92 | 1.30 | $313.43 | +$6.90 |
Testing for presence of drug (80307) | $79.81 | $71.83 | 3.38 | $236.07 | -$3.74 |
Hemoglobin A1C level (83036) | $13.32 | $11.99 | 19.68 | $232.32 | -$24.34 |
Gene analysis (colorectal cancer) (81528) | $512.43 | $508.87 | 0.34 | $167.67 | +$50.66 |
Drug test(s), definitive, per day; 15-21 drug class(es), including metabolite(s) if performed (G0482) | $204.34 | $198.74 | 0.82 | $159.32 | -$2.96 |
Blood test, basic group of blood chemicals (80048) | $11.60 | $10.44 | 12.72 | $132.52 | +$2.70 |
Molecular pathology procedure level 9 (81408) | NA | $2,000.00 | 0.06 | $117.92 | New to CLFS |
Parathormone (parathyroid hormone) level (83970) | $56.62 | $50.96 | 2.34 | $115.90 | -$9.34 |
Drug test(s), definitive, per day; 1-7 drug class(es), including metabolite(s) if performed (G0480) | $117.65 | $114.43 | 1.05 | $113.94 | +$3.69 |
Cyanocobalamin (vitamin B-12) level (82607) | $20.68 | $18.61 | 5.63 | $102.53 | -$11.32 |
Drug test(s), definitive, per day; 8-14 drug class(es), including metabolite(s) if performed (G0481) | $160.99 | $156.59 | 0.64 | $96.59 | -$4.08 |
PSA (prostate specific antigen) measurement (84153) | $25.23 | $22.71 | 4.30 | $95.57 | -$9.64 |
Thyroxine (thyroid chemical) measurement (84439) | $12.37 | $11.13 | 7.26 | $79.42 | -$6.76 |
Test for detecting genes associated with breast cancer (81519) | $3443.30 | $3,873.00 | 0.02 | $76.62 | +$16.48 |
Bacterial colony count, urine (87086) | $11.07 | $9.96 | 7.40 | $73.31 | -$9.08 |
Blood test, clotting time (85610) | $5.39 | $4.85 | 14.84 | $72.69 | -$19.48 |
Ferritin (blood protein) level (82728) | $18.70 | $16.83 | 3.94 | $65.12 | -$4.80 |
Natriuretic peptide (heart and blood vessel protein) level (83880) | $46.56 | $41.90 | 1.56 | $64.79 | -$5.68 |
Detection test for digestive tract pathogen (87507) | $571.72 | $514.55 | 0.12 | $56.79 | $22.57 |
Detection test for organism (87798) | $48.14 | $43.33 | 1.23 | $52.09 | $22.68 |
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