Comparison of Medicare Payment with Medicaid Payment
CPT CODE DESCRIPTION 2011 NUMBER OF ALLOWED TESTS 2011 MEDICARE-ALLOWED AMOUNT NUMBER OF TESTS WITH POTENTIAL FOR SAVINGS ALLOWED AMOUNT IF MEDICAID LOWEST RATE USED PERCENTAGE MEDICARE PAID MORE THAN MEDICAID 80048 Metabolic panel, total calcium 8,622,383 $85,612,322 5,668,213 $75,265,426 14% 80053 Comprehensive metabolic panel 26,667,106 $308,060,147 13,365,771 $279,044,002 10% 80061 Lipid panel 20,096,974 $293,294,006 […]
| CPT CODE | DESCRIPTION | 2011 NUMBER OF ALLOWED TESTS | 2011 MEDICARE-ALLOWED AMOUNT | NUMBER OF TESTS WITH POTENTIAL FOR SAVINGS | ALLOWED AMOUNT IF MEDICAID LOWEST RATE USED | PERCENTAGE MEDICARE PAID MORE THAN MEDICAID |
| 80048 | Metabolic panel, total calcium | 8,622,383 | $85,612,322 | 5,668,213 | $75,265,426 | 14% |
| 80053 | Comprehensive metabolic panel | 26,667,106 | $308,060,147 | 13,365,771 | $279,044,002 | 10% |
| 80061 | Lipid panel | 20,096,974 | $293,294,006 | 9,799,707 | $254,514,132 | 15% |
| 81001 | Urinalysis, automated, with microscopy | 6,636,868 | $29,518,138 | 6,307,849 | $25,392,723 | 16% |
| 81002 | Urinalysis, nonautomated, without microscopy | 4,153,597 | $14,808,195 | 3,980,171 | $11,481,389 | 29% |
| 81003 | Urinalysis, automated, without microscopy | 4,808,096 | $15,157,960 | 4,530,759 | $12,590,841 | 20% |
| 82306 | Vitamin D, 25 hydroxy | 5,308,512 | $218,018,917 | 5,200,763 | $173,834,730 | 25% |
| 82570 | Assay of urine creatinine | 4,432,117 | $31,958,084 | 4,274,416 | $26,437,934 | 21% |
| 82607 | Vitamin B-12 | 3,283,484 | $69,600,580 | 3,208,218 | $54,998,544 | 27% |
| 82728 | Assay of ferritin | 2,343,336 | $44,791,773 | 2,285,840 | $36,235,474 | 24% |
| 83036 | Glycosylated hemoglobin test | 12,374,324 | $168,495,108 | 11,889,154 | $139,534,720 | 21% |
| 83540 | Assay of iron | 2,573,826 | $22,783,202 | 2,416,826 | $17,777,978 | 28% |
| 83550 | Iron binding test | 2,001,213 | $24,090,743 | 1,952,675 | $18,554,959 | 30% |
| 83880 | Natriuretic peptide | 982,145 | $46,274,487 | 947,719 | $38,836,439 | 19% |
| 83970 | Assay of parathormone | 1,131,955 | $65,699,438 | 1,103,363 | $54,696,192 | 20% |
| 84153 | Assay of prostate-specific antigen, total | 3,530,885 | $91,280,209 | 3,415,111 | $78,423,161 | 16% |
| 84443 | Thyroid stimulating hormone | 14,431,323 | $340,218,728 | 13,470,738 | $278,608,047 | 22% |
| 85025 | Complete blood count with automated differential white blood cell count | 29,982,902 | $324,139,981 | 28,708,580 | $256,024,097 | 27% |
| 85610 | Prothrombin time | 19,778,756 | $109,118,351 /td> | 18,595,275 | $90,002,308 | 21% |
| 87086 | Urine culture colony count | 4,622,255 | $52,313,325 | 4,523,417 | $43,254,698 | 21% |
| Source: OIG Report; CMS, National Claims History Part B Carrier File, 2012. CPT codes © American Medical Association. | ||||||
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