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NPI 1164523478 · St Petersburg, FL · Clinical Medical Laboratory
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Hematopathology Associates LLC is a clinical medical laboratory provider located in St Petersburg, Florida. This profile covers 36 Medicare and 9 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 | Hematopathology Associates LLC |
| Address | 805 Executive Center Dr W Ste 300 |
| City | St Petersburg |
| State | FL |
| ZIP | 33702 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | September 26, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $13.6M |
| Medicaid | $37.8K |
HEMATOPATHOLOGY ASSOCIATES LLC operates as a high-complexity molecular diagnostics laboratory: its Medicare billing is dominated by full-gene and targeted sequencing codes (examples include 81238, 81307, 81321, 81201, 81162, 81226 and 81351), which correspond to coagulation gene sequencing, hereditary cancer genes (BRCA2/PALB2, PTEN, APC, TP53) and pharmacogenomic assays. The breadth of these codes indicates a service-line focused on hereditary cancer risk assessment, coagulation genetics, and pharmacogenomics rather than routine clinical chemistry or anatomic pathology services.
Medicare revenue concentration is material: the top 3 Medicare codes account for 28.2% of this provider’s total Medicare revenue, with 81238 (10.2%), 81307 (9.5%), and 81321 (8.5%) cited as the highest revenue contributors. This concentration suggests that a relatively small number of high-complexity genetic tests drive a large share of Medicare payments to the lab.
Payer mix is heavily skewed toward Medicare: lifetime Medicare revenue of $13.6M dwarfs lifetime Medicaid revenue of $37.8K, making this provider effectively Medicare-focused for scale and financial footprint. Medicaid activity is minimal by comparison, so Medicaid network value or risk exposure is likely limited.
Competitive standing on Medicare is notably strong for many specialized genetics codes: 81238 ranks #4 of 54 providers nationally (94th percentile), 81307 ranks #7 of 62 (90th percentile), and 81321 ranks #4 of 37 (92th percentile), indicating above-typical national volumes for these flagship assays. The lab is an outright national leader for several niche tests (examples: 81201 rank #1 of 28 at the 100th percentile; 81272 rank #1 of 16 at the 100th percentile; 81328 and 81227 also rank #1 at 100th percentiles), which signals dominant market share in particular assay types.
Medicaid billing is concentrated and modest: the top 3 Medicaid codes account for 88.5% of the provider’s total Medicaid revenue, led by 87798 at 67.9%, followed by 87481 at 12.4% and 87551 at 8.1%. These Medicaid code volumes are not especially strong in-state (for example, 87798 ranks #122 of 194 providers in-state, 37th percentile), so the provider is not a leading Medicaid lab for those assays within Florida.
The provider shows multiple statistical outlier signals on Medicare volume: several codes are labeled “extreme outlier, far above typical national volume” (for example 81201, 81225, 81328, 81227, 81240, 81291) while others are described as “notably above typical national volume” (for example 81238, 81162, 81226). These descriptors indicate systematic concentration of high volumes in specific high-complexity molecular assays relative to national peers, rather than a uniform distribution across test types.
Long-standing enumeration supports operational continuity: the NPI was enumerated 2006-09-26 (~20 years ago), consistent with an established laboratory operation that has scaled specialized genetic testing over time. Tenure of ~20 years increases the likelihood of sustained referral relationships with specialty clinics and payers.
For payer and provider contracting implications, this profile suggests negotiation focus areas: payers should treat HE MATOPATHOLOGY ASSOCIATES LLC as a high-volume provider for select hereditary cancer and pharmacogenomic assays when evaluating network inclusion and reimbursement for codes like 81238, 81307, and 81321. Given the heavy Medicare exposure and minimal Medicaid footprint, contracting and utilization management strategies should be calibrated primarily against Medicare volumes and specialty referral pathways rather than broad Medicaid network coverage.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
36 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81238 | The lab analyst performs the technical lab test to analyze the full gene sequence of the coagulation factor IX (F9) gene. | 2,240 | $590 | $1.3M |
| 81307 | The lab analyst performs the technical lab test on a specimen such as blood, to analyze the entire gene sequence for the partner and localizer of BRCA2 (PALB2) gene. | 1,840 | $660 | $1.2M |
| 81321 | The lab analyst performs the technical lab test to analyze the entire gene sequence for the phosphatase and tensin homolog, or PTEN, gene. | 1,860 | $590 | $1.1M |
| 81201 | The lab analyst performs the technical lab test to analyze the entire gene sequence for adenomatous polyposis coli, also known as APC. | 1,400 | $760 | $1.1M |
| 81162 | The lab analyst performs the technical lab test to analyze the entire gene sequence for the BRCA1, DNA repair–associated gene, also called BRCA1; and BRCA2, DNA repair–associated gene, also called… | 580 | $1,790 | $1M |
| 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. | 2,290 | $440 | $1M |
| 81351 | The lab analyst performs the technical lab test on a specimen such as blood to analyze the entire gene sequence for the tumor protein 53 (TP53) gene, which may indicate a diagnosis of Li–Fraumeni… | 1,430 | $630 | $900.7K |
| 81334 | The lab analyst performs the technical lab test to detect the presence of specific changes in the runt related transcription factor 1 (RUNX) gene for targeted sequence analysis, such as exons 3–8. | 1,900 | $320 | $612.7K |
| 81272 | The lab analyst performs the technical lab test for a partial gene sequence analysis for the v–kit Hardy–Zuckerman 4 feline sarcoma viral oncogene homolog, or KIT, gene. The analysis does not analyze… | 1,430 | $320 | $462.5K |
| 81314 | The lab analyst performs the technical lab test for a partial gene sequence analysis for the platelet–derived growth factor receptor, alpha polypeptide, or PDGFRA gene. The test does not analyze the… | 1,430 | $320 | $462.5K |
Showing 1–10 of 36
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 36 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
36 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81307 | 3 | 30 | 320 | $660 | $508.3K |
| 81321 | 3 | 30 | 430 | $580 | $467.7K |
| 81238 | 3 | 20 | 330 | $590 | $440.3K |
| 81162 | 3 | 20 | 100 | $1,780 | $403.3K |
| 81249 | 10 | 20 | 290 | $590 | $383.1K |
| 81223 | 10 | 20 | 340 | $490 | $329.3K |
| 81351 | 2 | 20 | 210 | $630 | $307.8K |
| 81334 | 3 | 20 | 390 | $320 | $295.7K |
| 81314 | 1 | 10 | 980 | $320 | $263.3K |
| 81306 | 1 | 10 | 810 | $290 | $231.8K |
Showing 1–10 of 36
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.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 310 | $80 | $25.7K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 130 | $40 | $4.7K |
| 87551 | The lab analyst performs a test for the presence of Mycobacterium species using amplified nucleic acid probe technique. Mycobacteria are bacteria, sometimes called acid fast bacteria, because of the… | 90 | $40 | $3.1K |
| 87581 | The lab analyst performs a test for Mycoplasma pneumonia, a bacteria, using amplified nucleic acid probe technique. | 40 | $30 | $1K |
| 87640 | The lab analyst performs the technical lab test to look for Staphylococcus aureus nucleic acid using an amplified probe technique. | 40 | $30 | $1K |
| 87651 | The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat. | 40 | $30 | $1K |
| 87653 | The lab analyst performs a test for Streptococcus, group B, using amplified nucleic acid probe technique. The amplified probe provides a rapid means to assess colonization by Streptococcus, group B,… | 40 | $30 | $1K |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 30 | $10 | $380 |
| 81241 | The lab analyst performs the technical lab test to detect the presence of a common change, called the Leiden variant, in the gene for coagulation factor V, also known as Factor V Leiden or F5. | 30 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Florida providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Florida median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 10 | 10 | 80 | $50 | $2.4M |
| 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… | 122 | 190 | 640 | $10 | $59.9K |
| 87651 | The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat. | 201 | 220 | 710 | $10 | $35.7K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 61 | 90 | 430 | $10 | $23.3K |
| 87653 | The lab analyst performs a test for Streptococcus, group B, using amplified nucleic acid probe technique. The amplified probe provides a rapid means to assess colonization by Streptococcus, group B,… | 60 | 70 | 560 | $10 | $9.6K |
| 87581 | The lab analyst performs a test for Mycoplasma pneumonia, a bacteria, using amplified nucleic acid probe technique. | 121 | 140 | 710 | $1 | $7.7K |
| 81241 | The lab analyst performs the technical lab test to detect the presence of a common change, called the Leiden variant, in the gene for coagulation factor V, also known as Factor V Leiden or F5. | 11 | 20 | 80 | $10 | $6.1K |
| 87640 | The lab analyst performs the technical lab test to look for Staphylococcus aureus nucleic acid using an amplified probe technique. | 51 | 60 | 480 | $1 | $5.3K |
| 87551 | The lab analyst performs a test for the presence of Mycobacterium species using amplified nucleic acid probe technique. Mycobacteria are bacteria, sometimes called acid fast bacteria, because of the… | 3 | 10 | 80 | $1 | $1.1K |
Other providers in the same ZIP code as Hematopathology Associates LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Precision Health Solutions, LLC | FL | Clinical Medical Laboratory | $1.3M | $654K |
| Kurt Hirshorn | FL | Orthopaedic Surgery Physician | $411.8K | $0 |
| Yasaman Mohadjer | FL | Ophthalmic Plastic and Reconstructive Surgery Physician | $228.4K | $0 |
| Paul Pagano | FL | Orthopaedic Surgery of the Spine Physician | $214.5K | $0 |
| Dzi-viet Nguyen | FL | Orthopaedic Hand Surgery Physician | $196.4K | $0 |
| Daniel Funsch | FL | Emergency Medicine Physician | $180K | $0 |
| Donald Lanza | FL | Otolaryngology Physician | $148.2K | $0 |
| Alla Solyar | FL | Otolaryngology Physician | $129.7K | $0 |
| Guy Petito | FL | Optometrist | $71.3K | $0 |
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