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Medicare Part B spending on lab tests increased in 2021, driven by higher volume of COVID-19 tests, genetic tests, and chemistry tests
Medicare Part B spending on lab tests increased in 2021, driven by higher volume of COVID-19 tests, genetic tests, and chemistry tests
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Data brief (United States. Department of Health and Human Services. Office of Inspector General)
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- Washington, D.C. : U.S. Department of Health and Human Services, Office of Inspector General, December 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Clinical Chemistry Tests
COVID-19 Testing
Genetic Testing
Government Regulation
Medicare Part B -- economics
United States - Genre(s):
- Technical Report
- Abstract:
- Medicare Part B spending on laboratory (lab) tests increased by $1.3 billion in 2021, from $8.0 billion in 2020 to $9.3 billion in 2021. The 17-percent increase was the biggest change in spending since OIG began monitoring payments in 2014. In 2021, Medicare Part B spent $2.0 billion on COVID-19 tests, a 29-percent increase from 2020. Medicare Part B paid for 26 different procedure codes for COVID-19 tests, including code U0005, a new code that incentivized faster test turnaround times. More than 10 million enrollees received at least 1 COVID-19 test paid for by Medicare Part B. Medicare Part B spending on non-COVID-19 tests also increased. Total spending on four categories of high-priced genetic tests increased by 56 percent, from $1.2 billion in 2020 to $1.9 billion in 2021, exceeding pre-pandemic spending levels. Spending on chemistry tests - the largest category of tests by both spending and volume - increased from $1.9 billion in 2020 to $2.1 billion in 2021, but remained below pre-pandemic levels. Medicare Part B spent $5.5 billion in 2021 on the top 25 tests, which accounted for 59 percent of total test spending. The factors that affected overall spending also contributed to the increase in spending on the top 25 tests. These factors were the increased volume for COVID-19 tests, the continued growth of high-priced genetic tests, and the increased volume for panel and chemistry tests. Why OIG Did This Review. The Protecting Access to Medicare Act of 2014 (PAMA) changed the way the Medicare program sets payment rates for lab tests by aligning Medicare payment rates with rates paid by private payers. The Centers for Medicare & Medicaid Services (CMS) calculated new rates that took effect in 2018, lowering Medicare payment rates for many tests. As part of PAMA, Congress also mandated that the Office of Inspector General (OIG) publicly release an annual analysis of the top 25 tests based on Medicare spending and that it conduct analyses that OIG determines appropriate. OIG issued the first report in 2015, analyzing Medicare Part B payments for lab tests in 2014. This data brief provides an analysis of Medicare payments for lab tests in 2021.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (12 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918713888706676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918713888706676