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NPI 1134438427 · South San Francisco, CA · Clinical Medical Laboratory
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Veracyte, Inc. is a clinical medical laboratory provider located in South San Francisco, California. This profile covers 8 Medicare and 13 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 | Veracyte, Inc. |
| Address | 6000 Shoreline Ct |
| City | South San Francisco |
| State | CA |
| ZIP | 94080 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | October 4, 2010 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $37.7M |
| Medicaid | $19.4M |
VERACYTE, INC. presents as a specialized clinical molecular laboratory where a small set of high-complexity genomic tests drive the business: Medicare billing is dominated by 81546 (32.5M revenue, $3509 avg paid/claim) and 81554 (2.9M revenue, $5400 avg paid/claim), while Medicaid also concentrates heavily on 81546 (12.6M revenue, $936 avg paid/claim) and 81545 (5M revenue, $1009 avg paid/claim). The code mix—large molecular pathology codes with high per-claim payments—indicates the operation focuses on proprietary or advanced genomic assays rather than general anatomic pathology alone. The top-3-code concentration supports this characterization, with the precomputed top 3 Medicare codes accounting for 97.6% of Medicare revenue and the top 3 Medicaid codes accounting for 94.3% of Medicaid revenue.
Revenue concentration is extreme across both payers: total Medicare revenue is $37.7M and total Medicaid revenue is $19.4M, yet the precomputed top-3 shares show most receipts flow through just a few tests (97.6% Medicare, 94.3% Medicaid). That concentration suggests the provider’s financial performance is highly sensitive to reimbursement and utilization changes for a handful of molecular tests, particularly 81546. These concentrations create operational leverage but also elevate payer negotiation and coverage risk around those core codes.
Payer mix shows Medicare is the larger single source by scale: the provider reports $37.7M in lifetime Medicare revenue versus $19.4M in lifetime Medicaid revenue. VERACYTE is therefore not single-payer dependent, but Medicare accounts for roughly the larger share of lifetime public-payer receipts as reported. Both payers, however, route most revenue to the same narrow set of molecular and cytology services, so product-level exposure spans both programs.
Competitive standing is dominant for several signature codes: 81546 ranks #1 of 1 providers nationally for Medicare (0th percentile; no national peer volume comparison available) and #1 of 1 providers in-state for Medicaid (0th percentile; no state peer volume comparison available), and 81554 ranks #1 of 1 providers nationally for Medicare as well. In addition, 88173 is described as an "extreme outlier" on Medicare (ranks #1 of 4276 providers nationally, 100th percentile) and on Medicaid within the state (ranks #1 of 65 providers in-state, 100th percentile), indicating unusually high volume for cytopathology fine-needle aspirate analysis relative to peers. These ranks portray VERACYTE as a market leader or sole-source operator for specific genomic assays in the datasets provided.
Operational footprint includes high cytology throughput alongside molecular testing: 88173 shows 10.8K Medicare claims (1.3M revenue, $124 avg paid/claim) and 16.6K Medicaid claims (699K revenue, $42 avg paid/claim), both flagged as extreme outlier volumes. That suggests the lab performs large volumes of fine-needle aspirate cytopathology in addition to its higher-revenue molecular assays, supporting an integrated diagnostic service line that pairs specimen collection/analysis with genomic reporting. This combination can increase per-specimen capture but also concentrates revenue drivers into a few workflows.
Pathology support codes show high claim counts but low revenue per claim, consistent with a lab that bundles high-volume ancillary pathology work with flagship tests: 88305 appears with 10.4K Medicare claims ($530.3K revenue, $51 avg paid/claim) and 17.2K Medicaid claims ($378.4K revenue, $22 avg paid/claim) and is characterized as notably above typical national and typical in-state volumes respectively. These lower-dollar, high-count services likely represent routine surgical pathology and interpretation support that accompanies molecular assays, contributing to throughput and case mix without driving major revenue on their own.
The provider uses a mix of unlisted/miscellaneous molecular codes in addition to named assays, indicating product diversity and ongoing test development or use of non-specific billing pathways: Medicare shows 81479 with 134 claims ($343.8K revenue, $2566 avg paid/claim; rank #41 of 80, 49th percentile) while Medicaid lists 81479 with 2.1K claims ($194.8K revenue, $91 avg paid/claim; rank #13 of 45, 73rd percentile) and other unique codes such as 0204U, 0208U, and 81545 in-state. These entries suggest a catalog that includes both established proprietary tests and miscellaneous or tiered molecular pathology reporting mechanisms across payers.
VERACYTE, INC. has an established presence based on NPI tenure: the NPI was enumerated 2010-10-04 (~16 years ago), indicating a prolonged operational history in Medicare/Medicaid billing. The longevity combined with concentrated leadership in specific molecular codes points to a mature, specialized lab business that has sustained high-volume testing lines over multiple years. Analysts should treat the provider as a long-standing specialty laboratory with concentrated test-level exposure rather than a generalist pathology practice.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81546 | The lab analyst performs the technical lab tests on a thyroid fine needle aspiration (FNA) specimen for mRNA gene expression profiling of 10,196 genes and carries out an algorithmic analysis using… | 9,270 | $3,510 | $32.5M |
| 81554 | The lab analyst performs the technical lab test on a transbronchial biopsy specimen for mRNA gene expression profiling for 190 genes and carries out an algorithmic analysis using patient data and the… | 550 | $5,400 | $2.9M |
| 88173 | The lab analyst performs the technical lab test to analyze a cytopathology specimen from a fine needle aspirate and then interprets and reports the results. | 10,840 | $120 | $1.3M |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 10,400 | $50 | $530.3K |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 130 | $2,570 | $343.8K |
| 88341 | The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified… | 220 | $40 | $7.6K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 90 | $40 | $3.5K |
| 81210 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for B–Raf proto–oncogene, serine/threonine kinase, also known as BRAF. | 20 | $170 | $2.6K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.
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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.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81546 | The lab analyst performs the technical lab tests on a thyroid fine needle aspiration (FNA) specimen for mRNA gene expression profiling of 10,196 genes and carries out an algorithmic analysis using… | 13,490 | $940 | $12.6M |
| 81545 | N/A | 4,910 | $1,010 | $5M |
| 88173 | The lab analyst performs the technical lab test to analyze a cytopathology specimen from a fine needle aspirate and then interprets and reports the results. | 16,640 | $40 | $699K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 17,200 | $20 | $378.4K |
| 0204U | N/A | 1,130 | $200 | $230.5K |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 2,140 | $90 | $194.8K |
| 81406 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 7 molecular pathology code. | 2,460 | $40 | $96.1K |
| 81210 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for B–Raf proto–oncogene, serine/threonine kinase, also known as BRAF. | 2,640 | $30 | $87.2K |
| 0208U | N/A | 760 | $70 | $51K |
| 81345 | The lab analyst performs the technical lab test to analyze targeted genes, such as the promotor region for the telomerase reverse transcriptase gene (TERT). | 680 | $40 | $24.6K |
Showing 1–10 of 13
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
13 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81546 | The lab analyst performs the technical lab tests on a thyroid fine needle aspiration (FNA) specimen for mRNA gene expression profiling of 10,196 genes and carries out an algorithmic analysis using… | 1 | 10 | 13,490 | $940 | $12.6M |
| 81545 | N/A | 1 | 10 | 4,910 | $1,010 | $5M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 13 | 50 | 500 | $160 | $1.1M |
| 81401 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 2 molecular pathology code. | 11 | 20 | 410 | $20 | $280.6K |
| 81406 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 7 molecular pathology code. | 5 | 20 | 590 | $40 | $274.7K |
| 0204U | N/A | 1 | 10 | 1,130 | $200 | $230.2K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 64 | 830 | 880 | $40 | $195.6K |
| 81311 | The lab analyst performs the technical lab test to analyze variants in exon 2, such as codons 12 and 13, and exon 3, such as codon 61, for the neuroblastoma RAS viral, v–ras, oncogene homolog, also… | 4 | 10 | 2,720 | $50 | $151K |
| 81275 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene Kirsten rat sarcoma viral oncogene homolog, also known as KRAS, which occur in exon 2. | 4 | 10 | 3,090 | $40 | $149.7K |
| 81210 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for B–Raf proto–oncogene, serine/threonine kinase, also known as BRAF. | 4 | 10 | 3,510 | $30 | $136.6K |
Showing 1–10 of 13
Other providers in the same ZIP code as Veracyte, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Myriad Women's Health, Inc. | CA | Clinical Medical Laboratory | $0 | $146.7M |
| Monogram Biosciences, Inc | CA | Clinical Medical Laboratory | $406.8K | $7.3M |
| Laguna Hills Pathology Lab LLC | CA | Clinical Medical Laboratory | $1M | $1.1M |
| Sebastian Sasu | CA | Anatomic Pathology & Clinical Pathology Physician | $180.2K | $0 |
| Jenny Kuo | CA | Anatomic Pathology & Clinical Pathology Physician | $76K | $0 |
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