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NPI 1043344435 · San Diego, CA · Clinical Medical Laboratory
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Biotheranostics, Inc. is a clinical medical laboratory provider located in San Diego, California. This profile covers 3 Medicare and 5 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Biotheranostics, Inc. |
| Address | 6333 Sequence Dr |
| City | San Diego |
| State | CA |
| ZIP | 92121 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | March 15, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $38.4M |
| Medicaid | $4M |
BIOTHERANOSTICS, INC. operates as a specialized molecular oncology laboratory: its top billed services are high-complexity genomic assays (81518 and 81540) that provide mRNA gene expression profiling and multi-gene RT–PCR tumor typing, supported by occasional specimen microdissection codes (88381/88380). The code mix and descriptions point to a laboratory business model centered on algorithm-driven tumor prognostics and subtype prediction rather than routine anatomic pathology or broad outpatient testing volumes.
Revenue is highly concentrated within a narrow set of molecular oncology codes on Medicare: the provider reports $38.4M total Medicare revenue with the precomputed top 3 Medicare codes accounting for 100.0% of that revenue; 81518 alone accounts for $34.3M (89.2% of Medicare revenue) and 81540 contributes $4.2M (10.8%). This concentration indicates that Medicare billing is effectively driven by a small number of proprietary, high-reimbursement assays.
Medicaid revenue shows a similar concentration pattern but at a much smaller scale: the provider reports $4M total Medicaid revenue and the precomputed top 3 Medicaid codes account for 99.6% of that revenue. On Medicaid, 81518 contributes $3.6M (90.6%) and 81540 contributes $335.9K (8.3%), indicating the same two assays dominate both payers’ revenue streams.
Payer mix is heavily Medicare-weighted in absolute scale: Medicare revenue ($38.4M) is an order of magnitude larger than Medicaid revenue ($4M), making Medicare the primary commercial driver for the practice’s billed services. Although both payers cover the same specialty assays, the provider is effectively a Medicare-scale operation with a much smaller Medicaid footprint.
Competitive standing for the top assays shows the provider appears as a sole or unique reporter in the available peer datasets: 81518 and 81540 each rank #1 of 1 providers in their respective Medicare national and in-state Medicaid comparisons (0th percentile; no peer volume comparison available), which suggests this entity is the only listed source of these specific billed volumes in the provided datasets rather than demonstrating head-to-head market share against multiple peers. For lower-volume support codes the picture is different: 88381 ranks #83 of 224 nationally (62th percentile; typical, unremarkable volume), indicating routine participation for manual microdissection relative to national peers.
State-level Medicaid competition mirrors the national pattern for the flagship assays: 81518 and 81540 both rank #1 of 1 providers in-state (0th percentile; no state peer volume comparison available), while other codes like 88381 rank #8 of 11 in-state (30th percentile; typical, unremarkable volume). This suggests the lab is the principal in-state reporter for its core genomic tests in this dataset, with more ordinary participation on ancillary pathology codes.
There are notable payer differences in average paid amounts per claim for the same assays: 81518 is reported with $3785 avg paid/claim on Medicare versus $945 avg paid/claim on Medicaid, and 81540 shows $3672 avg paid/claim on Medicare versus $391 avg paid/claim on Medicaid. These stated averages indicate substantially lower Medicaid payment levels for the same high-complexity assays, which has operational and margin implications for a lab that bills these tests to both payers.
The provider is long-tenured in the NPI registry, enumerated on 2007-03-15 (~19 years ago), supporting a sustained specialty lab presence. The duration combined with concentrated, high-reimbursement molecular testing suggests an established clinical diagnostics operation focused on oncology genomic services rather than a newly launched or generalist laboratory.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81518 | The lab analyst performs the technical lab tests for mRNA gene expression profiling for 11 genes and carries out an algorithmic analysis using patient data and the lab–test results to report a… | 9,050 | $3,790 | $34.3M |
| 81540 | The lab analyst performs the technical lab tests using real–time reverse transcription–polymerase chain reaction (RT–PCR) for 92 genes using tumor tissue. The lab analyst also carries out an… | 1,130 | $3,670 | $4.2M |
| 88381 | A clinician, typically a pathologist, performs a manual microdissection of a patient’s specimen, such as a biopsy or tissue preserved from a previous case. | 60 | $100 | $5.8K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81518 | The lab analyst performs the technical lab tests for mRNA gene expression profiling for 11 genes and carries out an algorithmic analysis using patient data and the lab–test results to report a… | 3,860 | $950 | $3.6M |
| 81540 | The lab analyst performs the technical lab tests using real–time reverse transcription–polymerase chain reaction (RT–PCR) for 92 genes using tumor tissue. The lab analyst also carries out an… | 860 | $390 | $335.9K |
| 88380 | The analyst uses a laser to obtain desired cells from microscopic tissue sections for further study. | 730 | $40 | $27.9K |
| 88381 | A clinician, typically a pathologist, performs a manual microdissection of a patient’s specimen, such as a biopsy or tissue preserved from a previous case. | 110 | $100 | $11.1K |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 10 | $240 | $3.1K |
How this provider's Medicaid billing volume and revenue compare to other California providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. California median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81518 | The lab analyst performs the technical lab tests for mRNA gene expression profiling for 11 genes and carries out an algorithmic analysis using patient data and the lab–test results to report a… | 1 | 10 | 3,860 | $940 | $3.6M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 43 | 50 | 500 | $160 | $1.1M |
| 81540 | The lab analyst performs the technical lab tests using real–time reverse transcription–polymerase chain reaction (RT–PCR) for 92 genes using tumor tissue. The lab analyst also carries out an… | 1 | 10 | 860 | $390 | $336K |
| 88381 | A clinician, typically a pathologist, performs a manual microdissection of a patient’s specimen, such as a biopsy or tissue preserved from a previous case. | 8 | 10 | 410 | $80 | $259.5K |
| 88380 | The analyst uses a laser to obtain desired cells from microscopic tissue sections for further study. | 1 | 10 | 730 | $40 | $27.9K |
Other providers in the same ZIP code as Biotheranostics, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Precision Toxicology, LLC | CA | Clinical Medical Laboratory | $13.8M | $213.8M |
| Veracyte Labs Sd Corporation | CA | Clinical Medical Laboratory | $75M | $2.4M |
| Sequenom Center For Molecular Medicine LLC | CA | Clinical Medical Laboratory | $0 | $74.1M |
| H&m Molecular Diagnostics, LLC | CA | Clinical Medical Laboratory | $13.3M | $11.2M |
| Helix, Inc. | CA | Clinical Medical Laboratory | $169.2K | $22.6M |
| Scripps Health | CA | Clinical Medical Laboratory | $8.9M | $301.7K |
| Biocept, Inc. | CA | Clinical Medical Laboratory | $254.7K | $5.6M |
| Iain Macewan | CA | Radiation Oncology Physician | $2.2M | $0 |
| Prometheus Laboratories Inc. | CA | Clinical Medical Laboratory | $338.8K | $1.6M |
| Neogenomics Laboratories Inc | CA | Clinical Medical Laboratory | $1.8M | $0 |
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