U.S. Department of Health and Human Services 
Office of Inspector General 
Data Snapshot 
December 2023, OEI-09-23-00350 
Medicare Part B Spending on Clinical Diagnostic Laboratory Tests in 2022   
Key Takeaways 
  In 2022, total Medicare Part B spending on clinical diagnostic 
laboratory tests (lab tests) decreased by 10 percent from total lab  Protecting Access to Medicare 
test spending in 2021.  Act of 2014 (PAMA)   
  Medicare Part B spending on lab tests has experienced an upward  To help control lab test spending, 
trend since 2014, the first year OIG began this series of annual  PAMA required that Medicare Part 
analysis required by PAMA.   B payment rates align with rates 
  Because payment rates for individual lab tests did not change in  paid by private payors.1  From 2018 
through 2020, CMS implemented 
2021 and 2022, changes in spending were primarily driven by 
new Medicare Part B lab test 
changes in the volume of tests.   
payment rates.  From 2021 through 
  Decreases in spending and volume occurred for most, but not all, 
2023, changes in legislation have 
individual lab tests and for each category of testsCOVID-19 
delayed any rate changes; the next 
tests; genetic tests; and chemistry and other tests.   
payment rate changes are 
scheduled for January 1, 2026.2  
What OIG Did 
Since 2014, OIG has been reporting 
In this report, we analyzed Medicare Part B claims data for lab tests paid for 
on lab test spending in Medicare 
by the Centers for Medicare and Medicaid Services (CMS) under the Clinical 
Part B as mandated by PAMA. 
Laboratory Fee Schedule (CLFS) 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. 
 
  Total Spending in 2022   
Total Medicare Part B spending grew between 2014 and 2022, with a sharp increase to $9.3 billion in 
2021 and a drop to $8.4 billion in 2022.  The 10-percent decrease in spending on lab tests in 2022 marks the 
largest decrease in annual spending since 2014. 
$9.3B 
 
$8.4B 
$8.0B 
$7.6B  $7.7B 
$7.1B 
$7.0B  $7.0B 
$6.8B 
2014 2015 2016 2017 2018 2019 2020 2021 2022
Source: OIG analysis of 2014-2022 Medicare Part B claims data, 2023. 
  1   
   Total Spending by Category   
 
Medicare Part B spent less on COVID-19 and genetic tests in 2022 compared to 2021.  The largest share 
of Medicares Part B total spending on lab tests continued to be for chemistry and other tests. 
$9.3B
$8.4B
$8.0B $2.0B
$7.6B $7.7B
$1.7B
$969M $1.5B COVID-19
$1.5B
$1.9B
$1.4B
$1.2B
Genetic
$5.3B 
$6.6B 
$6.2B 
Chemistry
$5.3B  $5.5B 
and
Other Tests
2018 2019 2020 2021 2022
Source: OIG analysis of 2018-2022 Medicare Part B claims data, 2023.   
 
Because of rounding, spending in the lab test categories may not sum to the total spending for the year. 
 
  COVID-19 Tests   
 
Medicare Part B spending on COVID-19 tests decreased by 14 percent in 2022. 
Total Medicare Part B spending on COVID-19 
COVID-19 tests represented a smaller share 
tests decreased from $2.0 billion in 2021 to  
of Medicare Part B spending for lab tests in 
$1.7 billion in 2022.  Widespread availability of  
2022.  COVID-19 tests accounted for  
at-home COVID-19 tests and the overall decline 
21 percent of spending for lab tests in 2021 
in the number of COVID-19 cases may have led to 
compared to 20 percent in 2022. 
a decrease in demand for laboratory (lab)-
performed COVID-19 tests in 2022.3, 4 
Under Medicare Part B, fewer COVID-19 
 
  14% tests were performed by labs in 2022.  
  $2.0B decrease The volume of COVID-19 tests that 
  $1.7B Medicare Part B paid for decreased from 
  25.8 million tests in 2021 to 23.3 million 
 
tests in 2022 (10-percent decrease).5 
Fewer Medicare Part B enrollees 
received a lab-performed COVID-19 test 
in 2022.  The number of enrollees who 
received COVID-19 tests decreased 
2021 2022
from 10.1 million enrollees in 2021 to 
Source: OIG analysis of 2021-2022 Medicare Part B claims 
8.5 million enrollees in 2022  
data, 2023. 
(16-percent decrease). 
  2   
  Genetic Tests   
 
Medicare Part B spending on genetic tests decreased by 26 percent in 2022.
Total Medicare Part B spending on genetic tests 
  Genetic tests represented a smaller 
decreased from $1.9 billion in 2021 to $1.4 billion 
share of Medicare Part B spending for 
in 2022.  The decrease in spending for genetic   
lab tests in 2022.  It accounted for  
tests is driven largely by a sharp decrease in 
  20 percent of spending for lab tests in 
spending for molecular pathology tests, from  
  2021 compared to 17 percent in 2022. 
$829 million in 2021 to $259 million in 2022  
(69-percent decrease).  This genetic test category   
has received scrutiny due to potential fraudulent 
billing activities by providers.6    Under Medicare Part B, fewer genetic 
tests were performed in 2022.  The 
 
  volume of genetic tests that Medicare 
  $1.9B 26%   Part B paid for decreased from  
decrease
  2.8 million tests in 2021 to 1.7 million 
  $1.4B   tests in 2022 (39-percent decrease). 
 
   
 
   
 
   
  The number of procedure codes for 
 
 
  genetic tests that Medicare Part B paid 
 
   
for increased from 365 codes in 2021 to  
 
   
2021 2022 382 codes in 2022. 
  Source: OIG analysis of 2021-2022 Medicare Part B claims 
data, 2023. 
 
  Top 25 Lab Tests   
Total spending for the top 25 Medicare Part B lab tests decreased in 2022, with decreases in volume 
for 15 individual tests and increases for the remaining 10 tests. 
Total spending on the top 25 Medicare Part B lab tests decreased by 13 percent, from $5.5 billion in 2021 to  
$4.8 billion in 2022.  Despite the decline in total spending for COVID-19 tests, the COVID-19 test with procedure 
code U0003 (line 1 on the next page) accounted for the largest Medicare Part B spending among all lab tests 
covered by the CLFS in 2022 ($663.5 million).  In addition, all four genetic tests in the top 25 had increased 
spending.  Although these four genetic tests had relatively low volume, they significantly contributed to Medicare 
Part Bs total spending on lab tests due to their high rates.  Payment rates for these tests ranged from $508.87 to  
$5,000.00 per test. 
 
  3   
  Top 25 Lab Tests   
 
  Test Description (Procedure Code)  2022  2022  Volume  2022 
  payment  volume  change from  spending 
rate  (millions)  2021  (millions) 
1  COVID-19 test:  Infectious agent detection by nucleic acid for  $75.00  9.0    -28.4%  $663.5 
COVID-19, high-throughput (U0003) 
2  Blood test, comprehensive group of blood chemicals (80053)  $10.56  38.7    -2.2%  $410.3 
3  Blood test, lipids (80061)  $13.39  25.6    -3.4%  $338.6 
4  Blood test, thyroid stimulating hormone (84443)  $16.80  19.3    -3.0%  $320.3 
5  Complete blood cell count, automated test (85025)  $7.77  36.8    -2.9%  $287.9 
6  Genetic test: Gene analysis (colorectal cancer) (81528)  $508.87  0.5    8.0%  $269.2 
7  Vitamin D-3 level (82306)  $29.60  8.8    -2.5%  $257.5 
8  COVID-19 test: Infectious agent detection by nucleic acid (DNA  $25.00  9.9    -19.3%  $244.6 
or RNA); severe acute (U0005) 
9  Detection test by nucleic acid for organism (87798)  $35.09  6.5    6.6%  $224.4 
10  COVID-19 test:  Any technique, high-throughput  $75.00  2.5    -14.7%  $186.3 
technologies (U0004) 
11  Hemoglobin A1C level (83036)  $9.71  18.2    -2.1%  $176.2 
12  Drug test(s), definitive, 22 or more drug class(es) (G0483)  $246.92  0.7    -16.0%  $168.4 
13  Testing for presence of drug, by chemistry analyzers (80307)  $62.14  2.3    -8.0%  $142.1 
14  Drug test(s), definitive, 15-21 drug class(es) (G0482)  $198.74  0.6    -4.5%  $122.9 
15  Parathormone (parathyroid hormone) level (83970)  $41.28  2.6    3.3%  $103.3 
16  COVID-19 test:  Amplified DNA or RNA probe detection of  $51.31  1.8    -8.3%  $94.8 
severe acute respiratory syndrome (87635) 
17  COVID-19 test:  Detection test by immunoassay technique  $-  2.7    2.2%  $93.8 
for severe acute respiratory syndrome (87426) 
18  Genetic test: Test for detecting genes associated with breast  $3,873.00  0.02    2.0%  $93.3 
cancer (81519) 
19  Genetic test: Test for detecting genes associated with  $2,919.60  0.03  New to top 25  $91.5 
cancer (81455) 
20  Cyanocobalamin (vitamin B-12) level (82607)  $15.08  5.9    1.3%  $87.9 
21  Blood test, basic group of blood chemicals (Calcium, total)  $8.46  9.7    -5.8%  $84.2 
(80048) 
22  Drug test(s), definitive, 1-7 drug class(es) (G0480)  $114.43  0.7    -4.3%  $81.8 
23  COVID-19 test:  Respiratory infectious agent detection by  $142.63  0.6  New to top 25  $81.2 
RNA for severe acute respiratory (0241U) 
24  Genetic test: Gene analysis of 55-74 genes associated with solid  $5,000.00  0.02    82.7%  $80.5 
organ cancer in cell-free (0242U) 
25  PSA (prostate specific antigen) measurement, total (84153)  $18.39  4.2    0.2%  $76.6 
Total Medicare Part B spending on the top 25 lab tests in 2022: $4.8 billion 
Sources: OIG analysis of 20212022 spending on lab tests in Medicare Part B, 2023.  Payment rates are from the 2022 CLFS.  
Local Medicare Administrative Contractors are responsible for developing the payment amount for claims they receive for 
some newly created procedure codes until Medicare establishes national payment rates (e.g., procedure code 87426,  
line 17). 
The five-character codes and descriptions included in this data snapshot are obtained from Current Procedural Terminology 
(CPT), copyright 2022 by the American Medical Association (AMA).  CPT is developed by the AMA as a listing of descriptive 
terms and five-character identifying codes and modifiers for reporting medical services and procedures.  Any use of CPT 
outside of this data snapshot should refer to the most current version of the Current Procedural Terminology available from 
AMA.  Applicable FARS/DFARS apply. 
  4   
  Methodology   
 
Analysis: We based this report on our analysis of Medicare Part B claims data for lab tests performed in  
2022 and reimbursed under the CLFS payment system.  Through our analysis, we identified key statistics and 
trends for Medicare spending on lab tests.  We analyzed Medicare spending and test volume by procedure code 
and category.  Test volume is based on the number of units for which labs billed Medicare.  We calculated total 
spending for 2022 and compared that to the results from previous years.  In previous years, we presented 
spending on chemistry tests separate from the other tests category.  Because spending in each of these two 
categories has remained relatively stable over the years, for 2022, we combined chemistry tests spending with 
other tests spending. 
We did not include tests paid for under other payment systems, such as the payment system for critical access 
hospitals or the Hospital Outpatient Prospective Payment System.  Many of the lab tests performed in outpatient 
settings (such as hospitals, skilled nursing facilities, and dialysis facilities) are paid for under Medicare payment 
systems other than the CLFS.  We did not include claims for physician interpretation of tests.  At-home and over-
the-counter tests are paid for under Medicare payment systems other than the CLFS, which were also not 
included in this analysis. 
Labs bill for each test on the CLFS using a Healthcare Common Procedure Coding System (HCPCS) code, which 
we refer to as a procedure code.  The HCPCS is divided into two systems, referred to as Level I and Level II.  
Level I HCPCS codes are composed of Current Procedural Terminology (CPT) codes.  Level II HCPCS codes are 
established by CMS primarily for items, supplies, and non-physician services not covered by CPT codes.  We used 
CPT categories for all tests on the CLFS, except tests used to diagnose COVID-19, which were analyzed as a 
group.  For HCPCS Level II codes that are unique to the CLFS, we used categories previously assigned by CMS. 
  COVID-19 tests.  We used CPT test codes and HCPCS codes to identify 26 COVID-19 tests that were 
authorized for payment in 2022.  This set of codes includes viral tests, antibody tests, and respiratory panel 
tests that include COVID-19 in the panel.  We included in our analysis only tests paid for by Medicare  
Part B.  Tests that Medicare Part B enrollees received through other programs, such as community testing 
efforts, were not included unless they were paid for by Medicare Part B.  For analysis by Medicare enrollee, 
we identified enrollees by using the Health Insurance Claim Numbers on the claims.   
  Genetic tests.  We used CPT test codes and HCPCS codes to identify 382 genetic tests that were authorized 
for payment in 2022.  This set of codes includes molecular pathology tests, multianalyte algorithmic assays, 
genomic sequencing procedures, and proprietary lab analysis tests. 
  Top 25 lab tests.  We identified the top 25 lab tests on the basis of total spending in 2022 for each 
procedure code and calculated total spending for these tests.  For this group of tests, we calculated the 
change in the volume of test units paid for by Medicare from 2021 to 2022. 
Data Source: We used claims data from the National Claims History Physician/Supplier Part B claim files and 
National Claims History Outpatient files.  The Physician/Supplier Part B files primarily include claims from 
independent labs and physician office labs.  The Outpatient files primarily include claims from hospital labs.     
Limitations: Analysis for this report was conducted on claims that Medicare Part B had processed by June 2023.  
Data from past reports used the 16-month or 17-month files and, thus, may be marginally different from the 
set of claims used in 2023.  However, this set of claims is comparable to the 16-month and 17-month files.  
Standards: We conducted this study in accordance with the Quality Standards for Inspection and Evaluation 
issued by the Council of the Inspectors General on Integrity and Efficiency.  
 
  5   
  Acknowledgments and Contact   
Eunji Kim served as the team leader for this study.  Office of Evaluation and Inspections staff who provided 
support include Althea Hosein, Michael Novello, Chelsea Samuel, and Sara Swisher.  We would also like to 
acknowledge the contributions of other Office of Inspector General staff, including Mandy Brooks, Karen Lowe, 
and China Tantameng. 
This report was prepared under the direction of Blaine Collins, Regional Inspector General for Evaluation and 
Inspections in the San Francisco regional office, and Abby Amoroso and Michael Henry, Deputy Regional 
Inspectors General. 
To obtain additional information concerning this report, contact the Office of Public Affairs at 
Public.Affairs@oig.hhs.gov.  OIG reports and other information can be found on the OIG website at oig.hhs.gov. 
Office of Inspector General 
U.S. Department of Health and Human Services 
330 Independence Avenue, SW 
Washington, DC 20201 
  Appendix   
Prior Office of Inspector General Reports on Medicare Part B Spending and Payment Rates for Lab Tests 
 
Medicare Part B Spending on Lab Tests Increased in 2021,  OEI-09-22-00400  December 2022 
Driven By Higher Volume of COVID-19 Tests, Genetic Tests, 
and Chemistry Tests 
COVID-19 Tests Drove an Increase in Total Medicare Part B  OEI-09-21-00240  December 2021 
Spending on Lab Tests in 2020, While Use of Non-COVID-19 
Tests Decreased Significantly 
Federal COVID-19 Testing Report: Data Insights from Six  PRAC Health Care  January 2021 
Federal Health Care Programs*  Subgroup  
Despite Savings on Many Lab Tests in 2019, Total Medicare  OEI-09-20-00450  December 2020 
Spending Increased Slightly Because of Increased Utilization 
for Certain High-Priced Tests 
Medicare Laboratory Test Expenditures Increased in 2018,  OEI-09-19-00100  August 2020 
Despite New Rate Reductions 
Medicare Payments for Clinical Diagnostic Laboratory Tests in  OEI-09-18-00410  September 2018 
2017: Year 4 of Baseline Data 
Setting Medicare Payment Rates for Clinical Diagnostic  OEI-09-17-00050  July 2018 
Laboratory Tests: Strategies To Ensure Data Quality 
Medicare Payments for Clinical Diagnostic Laboratory Tests in  OEI-09-17-00140  September 2017 
2016: Year 3 of Baseline Data 
  6   
Changing How Medicare Pays for Clinical Diagnostic  OEI-09-16-00100  September 2016 
Laboratory Tests: An Update on CMSs Progress 
 
Medicare Payments for Clinical Diagnostic Laboratory Tests in  OEI-09-16-00040  September 2016 
2015: Year 2 of Baseline Data  
Medicare Payments for Clinical Laboratory Tests in 2014:  OEI-09-15-00210  September 2015 
Baseline Data 
Comparing Lab Test Payment Rates: Medicare Could Achieve  OEI-07-11-00010  June 2013 
Substantial Savings 
Variation in the Clinical Laboratory Fee Schedule   OEI-05-08-00400  July 2009 
*This report was released by the Pandemic Response Accountability Committee Health Care Subgroup and included analysis of 
Medicare Part B claims for COVID-19 tests performed between February 1, 2020, and August 31, 2020. 
  Sources   
 
1
PAMA, P.L. No. 113-93 (April 2014),  216(a).  See also 42 CFR 414.507(a). 
2
CMS, Clinical Laboratory Fee Schedule.  Accessed at Summary of Private Payor Rate-Based Medicare Clinical 
Laboratory Fee Schedule (cms.gov) on December 12, 2023. 
3 Medicare Part B began covering up to eight over-the-counter (OTC) COVID-19 tests in April 2022.  CMS,  
COVID-19 Over-the-Counter Tests.  Accessed at COVID-19 Over-the-Counter Tests.  For information about free OTC 
COVID-19 tests for individuals with private health insurance or group health plan coverage, see U.S. Department of 
Health and Human Services, Biden-Harris Administration Requires Insurance Companies and Group Health Plans to 
Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests.  Accessed at 
https://www.hhs.gov/about/news/2022/01/10/biden-harris-administration-requires-insurance-companies-group-
health-plans-to-cover-cost-at-home-covid-19-tests-increasing-access-free-tests.html on November 3, 2023. 
4 CDC, Trends in United States COVID-19 Hospitalizations, Deaths, Emergency Department (ED) Visits, and Test 
Positivity by Geographic Area.  Accessed at https://covid.cdc.gov/covid-data-
tracker/#trends_weeklyhospitaladmissions_select_00 on November 3, 2023. 
5 We excluded procedure code U0005 from this analysis.  This code is an add-on code and can only be included on 
claims with procedure codes U0003 and U0004.  CMS Ruling 2020-1-R2.  Accessed at 
https://www.cms.gov/files/document/cms-ruling-2020-1-r2.pdf.   
6 OIG, Trends in Genetic Tests Provided Under Medicare Part B Indicate Areas of Possible Concern (A-09-20-03027) 
December 16, 2021.   
 
  7