U.S. Department of Health and Human Services 
 O  ffice of Inspector General 
 
Data Brief 
 December 2021, OEI-09-21-00240 
COVI D-19   Tests Drov e an Increase in Total Medicare Part B Spending 
on Lab Tests in 2020, While Use of Non-COVID-19 Tests Decreased 
Significantly 
Medicare Part B spending on clinical diagnostic laboratory (lab) tests 
Key Takeaway 
in 2020 was affected by significant new spending on COVID-19 tests, 
a type of test that did not exist before the pandemic.  Overall 
Medicare Part B spent $1.5 billion 
on COVID-19 tests in 2020, while  spending increased from $7.7 billion in 2019 to $8.0 billion in 2020.  
at the same time, spending on  This increase in spending 
non-COVID-19 tests declined by  was driven by $1.5 billion in 
$1.2 billion.  The result was a net  new spending on 
spending increase of 4 percent,  COVID-19 tests, including 
but the decrease in utilization of  $1.0 billion on a rapid 
non-COVID-19 tests raises  COVID-19 test procedure 
questions about the potential  code, which was the number 
impacts on beneficiary health.   1 test by spending.   
Aside from COVID-19 tests, 
spending for all other tests, as a group, decreased by about 
$1.2 billion in 2020.  The decline in spending was driven by a 
sharp decline in non-COVID-19 tests during the early months 
of the pandemic, as well as further reductions in payment rates 
for some of these tests, as required by the Protecting Access to 
Medicare Act of 2014 (PAMA). 
Why OIG Did This Review 
PAMA changed the way the Medicare program sets payment rates for lab tests by aligning Medicare 
payment rates with private payment rates.  The Centers for Medicare & Medicaid Services (CMS) 
calculated new rates that took effect in 2018.  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 conduct analyses that OIG determines appropriate.  This data brief provides an analysis of 
Medicare payments for lab tests in 2020. 
How OIG Did This Review 
We analyzed claims data for lab tests performed in 2020 that CMS paid for under the Clinical 
Laboratory Fee Schedule (CLFS).  These tests are covered under Medicare Part B and do not include 
COVID-19 tests provided by community testing programs or tests that Medicare paid for under other 
payment systems, such as the payment system for critical access hospitals or the Hospital Outpatient 
Prospective Payment System.  We identified the top 25 lab tests based on Medicare spending for tests 
performed in 2020.  We also identified key statistics and emerging trends, including Medicare spending 
by procedure code and test category.
   
RESULTS 
 
Medicare Part B spent $8.0 billion on laboratory tests in 2020, a 
4.2 percent increase from 2019 
Medicare Part B spending on laboratory (lab) tests increased 4.2 percent in 2020, 
reflecting significant new spending on COVID-19 testing and a decline in utilization of 
other lab tests due to the pandemic.  As shown in Exhibit 1, total spending has 
increased each year for the last 5 years.  The average annual increase in payments 
since 2016 has been about 4.3 percent per year; no year had a decrease in total lab 
test spending.  However, spending on non-COVID-19 tests in 2020 was the lowest it 
has been over this 5-year period. 
COVID-19 tests, a new type of test that did not exist before the COVID-19 pandemic 
emerged in 2020, accounted for the increase in spending for lab tests in 2020.  
COVID-19 tests accounted for about 19 percent of total Medicare Part B spending on 
lab tests.  Aside from COVID-19 tests, spending for all other tests as a group 
decreased by 15.9 percent from 2019, to $6.5 billion.  The decline in spending was 
driven by a decline in overall healthcare utilization during the pandemic, as well as a 
further reduction in payment rates for some tests, as required by PAMA. 
Exhibit 1: Medicare Part B spending on lab tests increased for the fifth year 
in a row, an increase largely driven by spending on new tests for COVID-19. 
Source: OIG analysis of 20162020 spending on lab tests in Medicare Part B, 2021. 
 
 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Results | 2  Medicare Part B spent $1.5 billion on COVID-19 tests in 2020, 
which accounted for 19 percent of total Medicare Part B 
spending on lab tests 
In 2020, Medicare Part B spent $1.5 billion on 25 unique procedure codes related to 
COVID-19 testing.  This set of tests included antibody tests, high-throughput tests 
with shorter test turnaround times, and panel tests that tested for COVID-19 along 
with other respiratory diseases.  Medicare Part B payment rates for COVID-19 tests 
ranged from $18.09 per test to $100 per test for high-throughput tests.  See Appendix 
B for more information about COVID-19 tests covered by Medicare Part B in 2020. 
Exhibit 2: Medicare Part B spending on COVID-19 tests increased throughout 
2020.
 
Source: OIG analysis of spending on lab tests in Medicare Part B, 2021. 
More than 8.4 million unique Medicare Part B beneficiaries received at least 1 COVID-
19 test paid under the CLFS in 2020.  On average, each unique beneficiary received 
two COVID-19 tests paid for by Medicare Part B.  Medicare Part B beneficiaries may 
have also received COVID-19 tests that were paid through other means, such as 
community testing programs. 
Overall Medicare Part B utilization of non-COVID-19 tests 
decreased significantly in 2020, compared to 2019 
Medicare Part B paid for fewer tests in total in 2020 than in 2019, driven by a sharp 
decline in testing in the spring of 2020.  For example, the number of non-COVID-19 
tests administered in April 2020 was 53 percent lower than in April 2019.  During this 
period, large segments of the U.S. economy, including parts of the healthcare sector, 
shut down to limit the community spread of COVID-19.  Non-COVID-19 diagnostic 
test volume declined dramatically in spring 2020, before returning to more typical 
utilization patterns in the summer.   
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Results | 3  Exhibit 3: The number of non-COVID-19 tests administered was 53 percent 
lower in April 2020 than in 2019.  
Source: OIG analysis of 20192020 spending on lab tests in Medicare Part B, 2021. 
The decline in test volume is consistent with CMS guidance on how facilities could 
respond to the evolving pandemic.  As the pandemic began, CMS issued guidance on 
April 7, 2020, that it developed in collaboration with medical societies and 
associations.  This guidance presented a tiered framework to prioritize services for 
urgent, life-saving situations where lack of in-person care could result in patient harm.  
For the lowest acuity tier, the guidance recommended that providers consider 
postponing non-emergent care and preventative screening procedures in order to 
limit exposure to COVID-19 for patients and providers.1 
Two months later, on June 8, 2020, CMS issued additional guidance on how facilities 
could safely resume non-emergent care that had been postponed.2  As shown in 
Exhibit 3, the number of non-COVID-19 tests that Medicare Part B beneficiaries 
received in June 2020 was 7 percent higher than the number of tests administered in 
June 2019.  However, the monthly volume of non-COVID-19 tests did not continue to 
increase during the second half of 2020, suggesting that many Medicare beneficiaries 
did not make up the tests they may have missed in the spring during the rest of 2020.  
Research suggests that delays in diagnostic testing, such as cancer screening, could 
have long-term effects on beneficiary health and well-being.3 
 
1 CMS, Non-Emergent, Elective Medical Services, and Treatment Recommendations.  Issued 
April 7, 2020.  Available at https://www.cms.gov/files/document/cms-non-emergent-elective-
medical-recommendations.pdf. 
2 CMS, Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare.  Issued 
June 8, 2020.  Available at https://www.cms.gov/files/document/covid-recommendations-
reopening-facilities-provide-non-emergent-care.pdf. 
3 For an example, see Alkatout, I., Biebl, M., Momenimovahed, Z., Giovannucci, E., Hadavandsiri, 
F., Salehiniya, H., & Allahqoli, L. (2021), Has COVID-19 Affected Cancer Screening Programs? A 
Systematic Review, Frontiers in Oncology, 11, 675038, available at 
https://doi.org/10.3389/fonc.2021.675038. 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Results | 4  Although testing rebounded in the second half of 2020, the number of non-COVID-19 
tests paid for by Medicare Part B during the full year declined by 12 percent.  For 
example, chemistry teststhe largest category by both volume and spending
experienced a 12 percent decline in volume, from 174 million in 2019 to 153 million in 
2020.  Chemistry tests measure the level of a chemicalsuch as a protein, electrolyte, 
or hormonein a specimen and providers use these tests to monitor a persons 
organ function and general health status.  See Appendix C for spending and volume 
for selected test categories. 
Medicare Part B spent $4.99 billion on the top 25 tests, which 
accounted for 62 percent of total spending in 2020 
Medicare Part B spending on the top 25 tests increased by 8 percent in 2020.  As with 
spending overall, COVID-19 tests had a significant impact on spending and volume 
among the top 25 tests.  Four COVID-19 tests were in the top 25 in 2020, as displayed 
on lines 1, 6, 24, and 25 in Exhibit 4 on page 6. 
The number 1 test by payments was a rapid COVID-19 test (procedure code U0003).  
Medicare Part B paid $1.02 billion for more than 10 million of these tests.  This marks 
the first time a new test entered the top 25 as the number 1 test since OIG began 
monitoring spending on the top 25 tests in 2014.  The number 2 test in 2020, the 
comprehensive group of blood chemicals test (procedure code 80053), had been the 
top test since new payment rates took effect in 2018.  Utilization of this blood 
chemicals test declined by 10 percent, from 42.2 million in 2019 to 37.8 million in 
2020, and payments declined by 18 percent.4 
Spending on 20 of the 21 non-COVID-19 tests in the top 25 tests decreased from 
2019 to 2020.  This set of tests includes routine screening tests that allow providers to 
identify potential issues in patients who would benefit from early intervention but 
may not have symptoms that require an urgent diagnosis.  Similarly, volume for each 
of the cancer screening tests in the top 25 decreased in 2020, as displayed in lines 9, 
18, 21, 22, and 23 of Exhibit 4 on page 6. 
Only one non-COVID-19 test in the top 25 increased from 2019 to 2020: a 
microbiology test that uses nucleic acid to detect an infectious agent (line 11).  
Volume increased by 92 percent and spending increased by 78 percent.  This test was 
likely used in conjunction with COVID-19 tests.5   
 
4 The payment rate for this test declined by 10 percent, from $11.74 in 2019 to $10.56 in 2020, 
which accounts for the disproportionate change in payments, relative to volume. 
5 CPT Assistant Special Edition: October Update, Volume 30, 2020.  Available at 
https://www.ama-assn.org/system/files/2020-10/cpt-assistant-guide-coronavirus-october-
2020.pdf. 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Results | 5  Exhibit 4: Medicare Part B spent $4.99 billion on the top 25 lab tests in 2020, including 
4 new COVID-19 tests. 
2020  2020  Volume  2020 
Test Description (Procedure Code)  payment  volume  change  spending 
rate  (millions)  from 2019   (millions) 
1  COVID-19 test: Infectious agent detection by nucleic acid for  $100  10.2  New    $1,017.0 
COVID-19, high-throughput (U0003) 
2  Blood test, comprehensive group of blood chemicals (80053)  $10.56  37.8    -10%   $402.7  
3  Blood test, lipids (80061)  $13.39  25.2    -12%   $336.2  
4  Blood test, thyroid stimulating hormone (84443)  $16.80  18.9    -12%   $315.4  
5  Complete blood cell count, automated test (85025)  $7.77  36.7    -11%   $288.5  
6  COVID-19 test: Any technique, high-throughput technologies  $100  2.4  New   $243.4 
(U0004) 

7  Vitamin D-3 level (82306)  $29.60  8.1    -9%   $237.6  

8  Drug test(s), definitive, 22 or more drug class(es) (G0483)  $246.92  0.9    -29%   $221.9  

9  Gene analysis (colorectal cancer) (81528)  $508.87  0.4    -14%   $208.1  

10  Molecular pathology procedure level 9 (81408)  $2,000  0.1    -31%   $205.4 

11  Detection test for organism (87798)  $35.09  5.2    92%   $183.5  

12  Hemoglobin A1C level (83036)  $9.71  17.6    -12%   $170.9  

13  Testing for presence of drug (80307)  $62.14  2.6    -24%   $161.0 

14  Drug test(s), definitive, 15-21 drug class(es) (G0482)  $198.74  0.7    -20%   $127.7  

15  Parathormone (parathyroid hormone) level (83970)  $41.28  2.3    -8%   $92.8 

16  Blood test, basic group of blood chemicals (80048)  $8.46  10.3    -18%   $89.6 

17  Drug test(s), definitive, 1-7 drug class(es) (G0480)  $114.43  0.8    -26%   $87.8  

18  Gene analysis (breast cancer 1 and 2) (81162)  $1,824.88  0.05    -21%   $86.7  

19   Drug test(s), definitive, 8-14 drug class(es) (G0481)  $156.59  0.5    -17%   $80.5  

20  Cyanocobalamin (vitamin B-12) level (82607)  $15.08  5.2    -11%   $78.4  

21  DNA gene analysis of 324 genes in solid organ tumor tissue  $3,500  0.02    -3%   $76.8 
(0037U) 

22  Test for detecting genes associated with breast cancer (81519)  $3,873  0.02    -9%   $76.6 

23  PSA (prostate specific antigen) measurement (84153)  $18.39  4.0    -8%  $73.8  
24  COVID-19 test: Amplified probe technique (87635)  -  1.4  New  $70.8  
25  COVID-19 test: Any technique (U0002)  -  1.2  New  $60.7  
Total 2020 spending on the top 25 tests: $4.99 billion 
Sources: OIG analysis of 20192020 spending on lab tests in Medicare Part B, 2021.  Payment rates are from the 2020 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. 
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 CPT codes.  The five 
character codes and descriptions included in this study are obtained from Current Procedural Terminology (CPT), copyright 2018 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 study should refer to 
the most current version of the Current Procedural Terminology available from AMA.  Applicable FARS/DFARS apply.  Level II HCPCS 
codes are established by CMS primarily for items, supplies, and non-physician services not covered by CPT codes. 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Results | 6   
CONCLUSION 
 
 
Lab tests have always played a critical role in providing important diagnostic 
information so that providers and beneficiaries can make appropriate treatment 
decisions.  This importance became even clearer in 2020, as the COVID-19 pandemic 
impacted all aspects of healthcare in the United States, including diagnostic testing.  
These trends affected both the increase in overall payments for lab tests in 2020 and 
the decline in volume for non-COVID-19 tests. 
The decline in volume for non-COVID-19 tests raises questions about the potential 
impacts on beneficiary health.  The decline in testing coincided with the height of 
COVID-19-related economic shutdowns, which affected many parts of the healthcare 
sector.  If Medicare beneficiaries delayed or avoided preventative healthcare services, 
they may not have received important tests, such as cancer screenings, that are 
medically necessary but not urgent.  Research suggests that delays of such lab tests 
could have a long-lasting impact on the health of some Medicare Part B beneficiaries. 
The COVID-19 pandemic will continue to have an impact on Medicare Part B 
spending on lab tests as the pandemic continues.  Testing strategy will continue to 
evolve as test technology and availability adjust to emerging variants.  OIG has a body 
of oversight work focused on the impact of the COVID-19 pandemic on Medicare 
beneficiaries.  Planned work includes an audit looking more closely at which lab tests 
had declines in volume in 2020.  We will also continue to monitor annual payments 
for lab tests, including COVID-19 tests. 
 
 
 
 
 
 
 
 
 
 
 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Conclusion | 7   
METHODOLOGY 
 
 
Data Analysis: We based this report on our analysis of Medicare claims data for lab 
tests performed in 2020 and reimbursed under the CLFS.  Through our analysis, we 
identified key statistics and emerging 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 2020 and compared that to the results from 2016 to 2019. 
  COVID-19 tests.  We used Current Procedural Terminology (CPT) test codes 
and HCPCS codes to identify 25 COVID-19 tests that were authorized for 
payment in 2020.  This set of codes includes viral tests, antibody tests, and 
respiratory panel tests that include COVID-19 in the panel.  We included only 
tests paid for by Medicare Part B in our analysis.  Tests that Medicare Part B 
beneficiaries received through other programs, such as community testing 
efforts, were not included, unless they were paid for by Medicare Part B.  For 
analysis by beneficiary, we identified beneficiaries by using the Health 
Insurance Claim Numbers on the claims.   
  Analysis by test category.  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. 
  Analysis by month.  We identified the number of tests paid for during each 
month in 2019 and 2020.  We calculated the number of COVID-19 tests paid 
for each month in 2020.  We used the dates of service to identify the month in 
which the test was performed. 
  Top 25 lab tests.  We identified the top 25 lab tests (on the basis of total 
spending for each procedure code) in 2020 and calculated total spending for 
these tests. For this group of tests, we calculated the change in the volume of 
test units paid for from 2019 to 2020. 
Data Source: The claims data were 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.  
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 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Methodology | 8  systems other than the CLFS.  We did not include claims for physician interpretation 
of tests. 
Limitations: Analysis for this report used the 16-month file, as it did in 2018 and 2019.  
In 2016 and 2017, we analyzed the 17-month file and, as a result, used a set of claims 
that was marginally more complete than sets used for other reports.  Thus, the totals 
for 2016 and 2017 are marginally higher than those reported for other years. 
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.
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Methodology | 9   
APPENDIX A 
 
Prior Office of Inspector General Reports on Medicare Part B 
Spending and Payment Rates for Lab Tests 
Federal COVID-19 Testing Report: Data Insights from  PRAC Health Care  January 2021 
Six Federal Health Care Programs*  Subgroup  
Despite Savings on Many Lab Tests in 2019, Total  OEI-09-20-00450  December 2020 
Medicare Spending Increased Slightly Because of 
Increased Utilization for Certain High-Priced Tests 
Medicare Laboratory Test Expenditures Increased in  OEI-09-19-00100  August 2020 
2018, Despite New Rate Reductions 
Medicare Payments for Clinical Diagnostic Laboratory  OEI-09-18-00410  September 2018 
Tests in 2017: Year 4 of Baseline Data 
Setting Medicare Payment Rates for Clinical  OEI-09-17-00050  July 2018 
Diagnostic Laboratory Tests: Strategies To Ensure Data 
Quality 
Medicare Payments for Clinical Diagnostic Laboratory  OEI-09-17-00140  September 2017 
Tests in 2016: Year 3 of Baseline Data 
Changing How Medicare Pays for Clinical Diagnostic  OEI-09-16-00100  September 2016 
Laboratory Tests: An Update on CMS's Progress 
 
Medicare Payments for Clinical Diagnostic Laboratory  OEI-09-16-00040  September 2016 
Tests in 2015: Year 2 of Baseline Data  
Medicare Payments for Clinical Laboratory Tests in  OEI-09-15-00210  September 2015 
2014: Baseline Data 
Comparing Lab Test Payment Rates: Medicare Could  OEI-07-11-00010  June 2013 
Achieve 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. 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Appendix A | 10   
APPENDIX B 
 
COVID-19 Tests Covered by Medicare Part B in 2020 
HHS OIG identified the following COVID-19 tests on the CLFS in 2020 that were used to identify 
current or past COVID-19 infections.  These COVID-19 tests include viral tests, which identify a 
current infection; antibody tests, which measure immune response; and respiratory panel tests, 
which use a single sample to test for multiple respiratory infections, including COVID-19.  This 
list also includes COVID-19 tests that use high-throughput technology, which enables labs to 
process more tests and thus return results to the beneficiary more quickly. 
All but one of the 25 tests were added to the CLFS in 2020.  One test (procedure code 86318) 
was on the CLFS prior to 2020 and was classified by AMA as a COVID-19 test on April 10, 2020.6  
Most of the new tests were contractor priced and some rates were adjusted throughout the 
year.  CMS established payment rates at its annual meeting in June 2020; new rates took effect 
in 2021.   
Test Name  HCPCS  Date added to the 
code  CLFS 
CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR  U0001  February 4, 2020 
Diagnostic Panel 
COVID-19, any technique, multiple types or subtypes (includes all  U0002  February 4, 2020 
targets), non-CDC  
Specimen collection for COVID-19, any specimen source.  Payment rate  G2023  March 1, 2020 
set at $23.46. 
Specimen collection for COVID-19, from an individual in a skilled  G2024  March 1, 2020 
nursing facility or by a laboratory on behalf of a home health agency, 
any specimen source.  Payment rate set at $25.46. 
Infectious agent detection by nucleic acid (DNA or RNA); COVID-19,  87635  March 13, 2020 
amplified probe technique 
Immunoassay infectious agent.  Existing test reclassified as a COVID-19  86318  Reclassified on  
test.  Payment rate set at $18.09.  April 10, 2020 
Immunoassay for infectious agent antibody, qualitative or  86328  April 10, 2020 
semiquantitative, single step method (e.g., reagent strip); COVID-19 
Antibody; COVID-19  86769  April 10, 2020 
 
6 CPT Assistant Special Edition: April Update, Volume 30, 2020.  Available at https://www.ama-
assn.org/system/files/2020-04/cpt-assistant-guide-coronavirus-april-2020.pdf. 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Appendix B | 11  Test Name  HCPCS  Date added to the 
code  CLFS 
Infectious agent detection by nucleic acid (DNA or RNA); COVID-19,  U0003  April 14, 2020 
amplified probe technique, making use of high-throughput 
technologies as described by CMS-2020-01-R.  Payment rate set at $100 
per test by CMS-2020-01-R.  
COVID-19, any technique, multiple types or subtypes (includes all  U0004  April 14, 2020 
targets), non-CDC, making use of high-throughput technologies as 
described by CMS-2020-01-R.  Payment rate set at $100 per test by 
CMS-2020-01-R. 
Infectious disease (bacterial or viral respiratory tract infection),  0202U  May 20, 2020 
pathogen-specific nucleic acid (DNA or RNA), 22 targets including 
COVID-19, qualitative RT-PCR, nasopharyngeal swab, each pathogen 
reported as detected or not detected 
Infectious disease (bacterial or viral respiratory tract infection),  0223U  June 25, 2020 
pathogen-specific nucleic acid (DNA or RNA), 22 targets including 
COVID-19, qualitative RT-PCR, nasopharyngeal swab, each pathogen 
reported as detected or not detected 
Antibody, COVID-19, includes titer(s), when performed  0224U  June 25, 2020 
Infectious agent antigen detection by immunoassay technique, (e.g.,  87426  June 25, 2020 
enzyme immunoassay [EIA], enzyme-linked immunosorbent assay 
[ELISA], immunochemiluminometric assay [IMCA]) qualitative or 
semiquantitative, multiple-step method; COVID-19  
Infectious disease (bacterial or viral respiratory tract infection)  0225U  August 10, 2020 
pathogen-specific DNA and RNA, 21 targets, including COVID-19, 
amplified probe technique, including multiplex reverse transcription for 
RNA targets, each analyte reported as detected or not detected  
Surrogate viral neutralization test (sVNT), severe acute respiratory  0226U  August 10, 2020 
syndrome COVID-19, ELISA, plasma, serum 
Neutralizing antibody, COVID-19; screen  86408  August 10, 2020 
Neutralizing antibody, COVID-19; titer  86409  August 10, 2020 
COVID-19: antibody, quantitative   86413  September 8, 2020 
Infectious disease (viral respiratory tract infection), pathogen-specific  0240U  October 6, 2020 
RNA, 3 targets (COVID-19, influenza A, influenza B), upper respiratory 
specimen, each pathogen reported as detected or not detected 
 
 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Appendix B | 12  Test Name  HCPCS  Date added to the 
code  CLFS 
Infectious disease (viral respiratory tract infection), pathogen-specific  0241U  October 6, 2020 
RNA, 4 targets (COVID-19, influenza A, influenza B, respiratory syncytial 
virus [RSV]), upper respiratory specimen, each pathogen reported as 
detected or not detected 
Infectious agent detection by nucleic acid (DNA or RNA); Bartonella  87636  October 6, 2020 
henselae and Bartonella quintana, amplified probe technique COVID-19 
and influenza virus types A and B, multiplex amplified probe technique 
Infectious agent detection by nucleic acid (DNA or RNA); Bartonella  87637  October 6, 2020 
henselae and Bartonella quintana, amplified probe technique COVID-19, 
influenza virus types A and B, and respiratory syncytial virus, multiplex 
amplified probe technique 
Infectious agent antigen detection by immunoassay with direct optical  87811  October 6, 2020 
(ie, visual) observation; Streptococcus, group B COVID-19 
Infectious agent antigen detection by immunoassay technique, (e.g.,  87428  November 10, 2020 
enzyme immunoassay [EIA], enzyme-linked immunosorbent assay 
[ELISA], fluorescence immunoassay [FIA], immunochemiluminometric 
assay [IMCA]) qualitative or semiquantitative; COVID-19 and influenza 
virus types A and B 
 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Appendix B | 13   
APPENDIX C 
 
Medicare Part B Spending and Utilization Details for Selected 
Test Categories 
Category Name  Volume  Spending 
2019  2020  Change  2019  2020  Change 
Chemistry  174.1M  152.9M  12%  $2.4B  $1.9B  18% 
COVID-19    18.8M      $1.5B   
Microbiology  36.5M  37.1M  2%  $762.3M  $891.0M  17% 
Organ or disease-oriented  88.7M  77.7M  12%  $1.09B  $871.8M  20% 
panels 
Drug tests  11.2M  8.7M  22%  $951.2M  $723.3M  24% 
Molecular pathology  1.6M  1.1M  29%  $848.9M  $540.3M  36% 
Multianalyte algorithmic  591,919  533,110  10%  $462.9M  $451.2M  3% 
assays 
Hematology and coagulation  69.0M  59.4M  14%  $500.2M  $404.4M  19% 
Immunology*  23.0M  19.2M  16%  $347.2M  $278.0M  20% 
Proprietary laboratory  54,394  91,663  69%  $117.0M  $132.2M  13% 
analyses 
Genomic sequencing  69,993  101,305  45%  $47.2M  $78.7M  66% 
procedures and other 
molecular multianalyte assays 
*In 2019, Medicare Part B spent $390,336.97 on the Immunology test that was reclassified in 2020 as a 
COVID-19 test.
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Appendix C | 14   
ACKNOWLEDGMENTS AND CONTACT 
 
 
Acknowledgments 
Chelsea Samuel served as the team leader for this study.  Office of Evaluation and 
Inspections staff who provided support include Michael Novello 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. 
Contact 
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 
 
 
 
Data Brief: COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of 
Non-COVID-19 Tests Decreased Significantly, OEI-09-21-00240  Acknowledgments and Contact | 15