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NPI 1073985727 · Mishawaka, IN · Clinical Medical Laboratory
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Toxusa Labs LLC is a clinical medical laboratory provider located in Mishawaka, Indiana. This profile covers 60 Medicare and 149 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 | Toxusa Labs LLC |
| Address | 236 W Edison Rd |
| City | Mishawaka |
| State | IN |
| ZIP | 46545 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | October 21, 2015 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $9.6M |
| Medicare | $1.3M |
TOXUSA LABS LLC shows a clear payer skew: Medicaid revenue ($9.6M) is far larger than Medicare revenue ($1.3M), making the provider effectively Medicaid-dominant in scale. This imbalance suggests the lab’s business model and contracts are weighted toward state-managed patients and payer relationships rather than Medicare volume.
Revenue is highly concentrated in a few line items for both payers: the provider’s top three Medicare codes account for 74.6% of Medicare revenue, and the top three Medicaid codes account for 58.1% of Medicaid revenue. On Medicare the single code G0482 generates $555.9K (42.4% of Medicare revenue), while on Medicaid U0003 generates $2.2M (26.8% of Medicaid revenue) and G0482 generates $1.8M (21.9% of Medicaid revenue), indicating reliance on a small set of high-return services.
The code mix indicates an operational focus on definitive toxicology and high-throughput molecular infectious disease testing: major Medicare and Medicaid drivers include G0482 and G0483 (definitive drug testing panels), and Medicaid volume is also dominated by U0003 (high-throughput SARS-CoV-2 testing) and large volumes of presumptive and targeted toxicology screens such as 80307 and related 803xx codes. Claim counts reinforce a high-throughput model — for example, Medicaid shows 38.7K claims for U0003 and 31.6K claims for G0482, consistent with centralized lab processing and large specimen throughput.
Competitive standing differs by payer and code: in-state Medicaid ranks show extreme prominence — U0003 ranks #3 of 89 in-state (98th percentile; extreme outlier, far above typical state volume) and G0482 ranks #1 of 16 (100th percentile; extreme outlier, far above typical state volume), and several 803xx screens rank at or near #1 in-state (100th percentile or notably above typical). These positions indicate TOXUSA is a dominant provider of COVID PCR and definitive drug-testing services within its state.
Nationally on Medicare the provider exhibits concentrated strength on definitive toxicology codes but is more of a focused specialist than a general national leader: G0482 ranks #21 of 1618 (99th percentile; typical, unremarkable volume for this code) and G0483 ranks #85 of 1063 (92th percentile; typical, unremarkable volume for this code), signaling above-average national placement on select drug-testing services while overall Medicare revenue remains modest. Notably, 81231 ranks #1 of 5 nationally (100th percentile; notably above typical national volume), indicating an unusual national presence for a specific pharmacogenomic test.
Payer-specific pricing and volume patterns are visible in the data: Medicare average paid/claim for G0482 is $195 and for G0483 is $242, while Medicaid average paid/claim for U0003 and G0482 is $58. These differences, coupled with the much larger Medicaid claim counts, imply Medicaid is the primary volume driver even where per-claim Medicare payments can be higher for certain codes.
The provider’s revenue concentration in a few codes represents an operational and contracting risk: with top-three concentration of 74.6% on Medicare and 58.1% on Medicaid, changes in coverage, coding rules, or state contracting for U0003/G0482/80307 could materially affect total revenue. Analysts should monitor policy changes to high-volume test categories (definitive toxicology panels and high-throughput infectious disease assays) that would disproportionately impact this lab.
TOXUSA’s NPI has been enumerated since 2015-10-21 (~11 years ago), indicating an established operations history; sustained, very large Medicaid claim volumes (for example, 38.7K claims for U0003 and 31.6K claims for G0482) suggest long-standing in-state relationships or contracts that support high throughput and steady Medicaid revenue.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
60 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| G0482 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 2,850 | $200 | $555.9K |
| G0483 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 1,240 | $240 | $299.6K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 3,600 | $30 | $122.3K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 1,670 | $60 | $101.9K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 740 | $70 | $55K |
| 81226 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for cytochrome P450, family 2, subfamily D, polypeptide 6, also known as CYP2D6. | 50 | $420 | $22.8K |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 130 | $150 | $19.1K |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,… | 740 | $30 | $18.5K |
| 81225 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for cytochrome P450, family 2, subfamily C, polypeptide 19, also known as CYP2C19. | 50 | $280 | $14.9K |
| 81227 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for cytochrome P450, family 2, subfamily C, polypeptide 9, also known as CYP2C9. | 60 | $170 | $10.6K |
Showing 1–10 of 60
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 60 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
149 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 38,700 | $60 | $2.2M |
| G0482 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 31,610 | $60 | $1.8M |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 34,110 | $20 | $784.6K |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 9,780 | $70 | $655.3K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 7,340 | $80 | $587.4K |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 13,110 | $40 | $471.8K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 15,320 | $20 | $260.5K |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,… | 17,580 | $10 | $228.5K |
| 87633 | The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for… | 1,120 | $160 | $183.4K |
| G0483 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 3,810 | $30 | $102.9K |
Showing 1–10 of 149
How this provider's Medicaid billing volume and revenue compare to other Indiana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Indiana median
149 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G0483 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 9 | 20 | 1,610 | $70 | $841.6K |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 5 | 30 | 400 | $90 | $443.4K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 13 | 190 | 800 | $40 | $344.7K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 3 | 90 | 1,150 | $60 | $289.6K |
| G0482 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 1 | 20 | 1,160 | $50 | $236.5K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 3 | 40 | 160 | $80 | $173.2K |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 9 | 90 | 390 | $40 | $171.1K |
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 28 | 50 | 310 | $90 | $169.3K |
| 87150 | The lab analyst performs an analysis using amplified DNA or RNA probe technique on a previously isolated and identified organism to categorize the organism more specifically, such as to the taxonomic… | 4 | 10 | 70 | $50 | $145.9K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 23 | 80 | 340 | $70 | $139.8K |
Showing 1–10 of 149
Other providers in the same ZIP code as Toxusa Labs LLC, ranked by combined Medicare and Medicaid revenue.
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