Medicare Part B Spending on Clinical Diagnostic Laboratory Tests in 2022

KEY TAKEAWAYS

In 2022, Medicare Part B spending on clinical diagnostic laboratory tests (lab tests) decreased by 10 percent from lab test spending in 2021. Medicare Part B spending on lab tests has experienced an upward trend since 2014, the first year OIG began this series of annual analysis required by the Protecting Access to Medicare Act of 2014 (PAMA). Because payment rates for individual lab tests did not change in 2021 and 2022, changes in spending were primarily driven by changes in the volume of tests. Decreases in spending and volume occurred for most, but not all, individual lab tests and for each category of lab tests—COVID-19 tests; genetic tests; and chemistry and other tests. Our data snapshot contains no recommendations.

WHY WE DID THIS STUDY

To help control lab test spending, PAMA required that Medicare Part B payment rates align with rates paid by private payors. From 2018 through 2020, the Centers for Medicare and Medicaid Services (CMS) implemented new Medicare Part B lab test payment rates. From 2021 through 2023, changes in legislation have delayed any rate changes; the next payment rate changes are scheduled for January 1, 2026. Since 2014, OIG has been reporting on lab test spending in Medicare Part B as mandated by PAMA.

WHAT OIG DID

In this report, we analyzed Medicare Part B claims data for lab tests paid for by CMS under the Clinical Laboratory Fee Schedule in 2022. We identified key statistics and trends for total Medicare spending on lab tests, including the top 25 lab tests on the basis of total spending.

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