Friday, December 25, 2020

Ten Labs Paid for 81408 in 2017; How their billings for Tier 2 codes looked in 2018

Payments for code 81408 have grown 580% from 2016 to 2019; see my main blog.

Only about ten labs were paid for >10 81408 services in CY2017.   

Coincidentally, about 80% of these labs were mentioned in DOJ documents called "operation double helix" (I'm inferring no meaning from that.)   

Here's today's exercise. 

If you take the ten labs which were paid for 81408 in CY2017, and look at their CY2018 payments for all lab services, you can can (A) highlight their payments  by level for all Tier 2 codes (81400-408) and (B) find out how much of all their lab payments were attributed to Tier 2 codes.


These ten labs  collectively were paid $135M for Tier 2 codes, which is about 70% of all Part B payments for Tier 2 codes in 2018 ($135M/$190M). (Here).   

Having collected this data, you can see how the Tier 2 payments for each lab distributed amongst the codes.   You'll see that one lab got paid 18% for 81407 and 69% for 81408, but most labs got 0% for 81407.  One lab got 93% of its 81400-81408 payments from 81408.   

If you look at the portion of all their lab payments these labs got from their Tier 2 genetic codes, it's 38% to a 88%, and usually >50%.   

Click to enlarge.


Payments for Tier 2 codes in 2017 were:

2017 shows $9.552M in total 81408 payments of which 9.462M went to just 9 entities.

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