Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Texas for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Texas only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Texas (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Department Of State Health Services (NPI 1114931391)

Field	Value
Entity Type	Organization
Organization	Department Of State Health Services
Address	1100 W 49th St
City	Austin
State	TX
ZIP	78756
Taxonomy	Clinical Medical Laboratory
NPI Enumerated	July 27, 2006

Payer Source	Total Paid
Medicaid	$382.5M
Medicare	$0

Key Findings

The provider’s Medicaid billing is overwhelmingly driven by newborn metabolic screening: S3620 shows 1.3M claims, $280 avg paid/claim and $370.9M revenue (97.0% of this provider's total Medicaid revenue). The code description and this scale indicate the organization is operating as a high-volume newborn screening laboratory rather than a general clinical testing practice.

Revenue concentration is extreme: the precomputed top 3 Medicaid codes account for 99.8% of the provider’s total Medicaid revenue ($382.5M). That degree of concentration signals a very narrow service mix where a single programmatic function (newborn metabolic screening plus a small set of related tests) produces virtually all billed Medicaid dollars.

This provider has no Medicare billing on file and $0 in Medicare revenue, making its financial footprint effectively single-payer with Medicaid ($382.5M) as the sole reported source. For analysts, that means payer mix risk is concentrated in state Medicaid policy and reimbursement changes rather than Medicare dynamics.

The provider is a dominant statewide performer on its top tests: S3620 ranks #1 of 106 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code), 83655 ranks #1 of 328 providers in-state (100th percentile; extreme outlier), and 85018 ranks #1 of 468 providers in-state (100th percentile; extreme outlier). These rankings and percentile placements characterize the lab as the primary in-state hub for newborn screening and related high-volume public health testing.

Secondary clinical-testing activity exists but is financially immaterial compared with the top codes: 80061 reports $687.6K (0.2% of Medicaid revenue) across 45.8K claims and ranks #7 of 573 providers in-state (99th percentile), while other common lab codes (e.g., 82947, 82465) each represent only tiny shares of revenue. These lines appear to be typical, unremarkable clinical volumes that supplement the lab’s public-health screening mission rather than constitute distinct revenue drivers.

Tenure data show the NPI was enumerated on 2006-07-27 (~20 years ago), indicating a long-established presence in Austin, TX operating under the Clinical Medical Laboratory taxonomy. That longevity is consistent with the role of a stable, centralized public-health laboratory handling mandated screening programs.

Because S3620 alone accounts for $370.9M (97.0% of Medicaid revenue) and the top three codes together represent 99.8% of Medicaid revenue, any changes to newborn screening reimbursement, reporting requirements, or state-level program scope could produce material revenue impact. Analysts should treat this provider as program-dependent with concentrated operational and policy exposure.

The dataset’s characterization of the top codes as "extreme outlier" and "far above typical state volume for this code" reinforces that the provider’s volumes are not just large but centralized; for Medicaid program planning and network design, this provider functions like a statewide reference or public-health lab rather than a conventional ambulatory laboratory vendor.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S3620	Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis;…	1,324,710	$280	$370.9M
83655	The lab analyst performs a test to measure the amount of lead in the patient specimen. A typical aim of the test is to check for lead exposure.	685,610	$10	$8.9M
85018	The lab analyst measures the hemoglobin in a whole blood sample. Hemoglobin is the red pigmented iron compound contained in the red blood cell that combines with oxygen needed by the body tissue.	623,390	$1	$1.9M
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	45,840	$20	$687.6K
82947	The lab analyst performs a test to measure the amount of glucose in a patient's blood using a method other than a reagent strip.	11,150	$1	$44.6K
82465	The lab analyst measures the level of total cholesterol in a patient specimen of serum or whole blood.	7,490	$10	$37.4K
86592	The lab analyst performs a test to detect the presence of syphilis–related antibodies in patient specimens using antigen tests such as rapid plasma reagin, called RPR; automated reagin test, called…	6,550	$10	$32.7K
83718	The lab analyst performs a test to directly measure the high density lipoprotein, HDL, cholesterol in a patient specimen.	1,300	$10	$11.7K
87389	The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an…	1,700	$10	$8.5K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	1,190	$10	$7.1K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Texas providers billing the same CPT/HCPCS codes.

Claims Volume vs. Texas Distribution

Department Of State Health Services — 6 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. Texas median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S3620	Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis;…	1	110	90	$270	$3.5M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	91	290	410	$20	$225K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	92	300	410	$20	$223.4K
87389	The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an…	38	150	220	$10	$177.1K
86780	The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to Treponema pallidum, a spiral shaped bacteria called a spirochete, that causes syphilis.	92	100	450	$10	$67.3K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	7	570	380	$10	$52.5K
83655	The lab analyst performs a test to measure the amount of lead in the patient specimen. A typical aim of the test is to check for lead exposure.	1	330	250	$10	$43K
86592	The lab analyst performs a test to detect the presence of syphilis–related antibodies in patient specimens using antigen tests such as rapid plasma reagin, called RPR; automated reagin test, called…	9	130	250	$1	$23.4K
83718	The lab analyst performs a test to directly measure the high density lipoprotein, HDL, cholesterol in a patient specimen.	5	10	60	$1	$5.6K
82465	The lab analyst measures the level of total cholesterol in a patient specimen of serum or whole blood.	2	30	80	$1	$5.3K

Showing 1–10 of 12

Nearby Providers

Other providers in the same ZIP code as Department Of State Health Services, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Paul Coffeen	TX	Clinical Cardiac Electrophysiology Physician	$462K	$0
David Kessler	TX	Clinical Cardiac Electrophysiology Physician	$365.9K	$0
Francis Zidar	TX	Interventional Cardiology Physician	$358.6K	$0
Jerome Thomas	TX	Advanced Heart Failure and Transplant Cardiology Physician	$285K	$0
Peter Wollan	TX	Ophthalmology Physician	$261.7K	$0
Kunjan Bhatt	TX	Advanced Heart Failure and Transplant Cardiology Physician	$258.5K	$0
Matthew Selmon	TX	Interventional Cardiology Physician	$233.4K	$0
Arthur Smith	TX	Interventional Cardiology Physician	$224.9K	$0
Mark Picone	TX	Interventional Cardiology Physician	$178.9K	$0
Jeffrey Apple	TX	Surgery Physician	$165.2K	$0

Department Of State Health Services — Billing Profile & Reimbursement Data

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Department Of State Health Services — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References