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NPI 1184045619 · Redwood City, CA · Clinical Medical Laboratory
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Guardant Health, Inc. is a clinical medical laboratory provider located in Redwood City, California. This profile covers 5 Medicare and 33 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 | Guardant Health, Inc. |
| Address | 505 Penobscot Dr |
| City | Redwood City |
| State | CA |
| ZIP | 94063 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | December 31, 2013 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $174.5M |
| Medicaid | $19.1M |
Guardant Health’s Medicare and Medicaid billing profile is heavily centered on proprietary next–generation sequencing (NGS) liquid-biopsy and tissue-based assays: the PLA codes 0242U, 0326U, and 0334U correspond to Guardant360® CDx, Guardant360®, and Guardant360 TissueNext™ NGS tests, indicating the operation functions primarily as a commercial molecular diagnostics lab focused on high-complexity genomic assays rather than routine anatomic pathology alone. The presence of both cell‑free DNA (blood) and FFPE tissue NGS PLA codes shows a product mix that includes both liquid biopsy and tissue-based genomic panels.
Medicare revenue is highly concentrated in three proprietary PLA codes: 0242U ($104.7M, 60.0% of Medicare revenue), 0326U ($59.3M, 34.0%), and 0334U ($5.5M, 3.2%); together the precomputed top 3 codes account for 97.2% of the provider’s $174.5M total Medicare revenue. This concentration signals that Guardant’s Medicare business is driven almost entirely by a small number of high-value NGS assays.
Medicaid billing also shows concentration but to a lesser extent: the top three Medicaid codes 0242U ($7.6M, 40.9%), 0326U ($3.3M, 17.8%), and 81479 ($1.4M, 7.4%) together account for 66.1% of the provider’s $19.1M total Medicaid revenue. Medicaid revenue is materially smaller than Medicare—$19.1M versus $174.5M—so while the same proprietary assays are important across payers, the scale is much larger on Medicare.
Competitive standing for the core proprietary PLAs is distinctive: 0242U and 0326U each rank #1 of 1 nationally for Medicare (0th percentile; no national peer volume comparison available) and also rank #1 of 1 in-state for Medicaid (0th percentile; no state peer volume comparison available). Those rank positions in the dataset indicate Guardant is the sole reporter for these PLA codes in the available claims universe, consistent with billing of manufacturer-specific tests rather than a distributed market share among many labs.
Guardant also bills non-proprietary molecular pathology and pathology codes at modest, more typical volumes alongside its PLA business: Medicare 81479 is $4.7M (rank #17 of 80, 80th percentile; typical, unremarkable volume) and Medicare 88360 is $191.7K (rank #18 of 5330, 100th percentile; typical, unremarkable volume). In Medicaid, 81479 appears as $1.4M (rank #10 of 45, 80th percentile; typical, unremarkable volume), indicating the provider participates in broader molecular pathology billing but without the outsized dominance seen for its proprietary PLAs.
At the state level in Medicaid, several single-gene and tiered molecular codes show Guardant at or near the top among a small set of providers: examples include 81201 ($747.5K, rank #1 of 4, 100th percentile; typical, unremarkable volume), 81321 ($574.3K, rank #2 of 5, 75th percentile; typical, unremarkable volume), and 81301 ($229.7K, rank #1 of 5, 100th percentile; notably above typical state volume for this code). These rank patterns suggest Guardant’s Medicaid footprint includes a range of targeted genetic tests and that for specific assays (e.g., MSI testing 81301) the provider reports volumes that are notably high relative to state peers.
The payer mix is Medicare‑dominant: total Medicare revenue is $174.5M compared with $19.1M in Medicaid, indicating Medicare accounts for the bulk of lifetime public‑payer receipts on file for this NPI. Analysts should treat Guardant as primarily reliant on Medicare fee-for-service and PLA reimbursement for its principal revenue stream.
The NPI tenure indicates Guardant Health has been enumerated in the NPI registry since 2013-12-31 (~13 years ago), reflecting more than a decade of billing history under this identifier—an established presence that aligns with its role as a specialized commercial genomic testing 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.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0242U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0242U for… | 21,420 | $4,890 | $104.7M |
| 0326U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0326U only for… | 16,800 | $3,530 | $59.3M |
| 0334U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0334U only for… | 1,940 | $2,860 | $5.5M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 1,030 | $4,520 | $4.7M |
| 88360 | The lab analyst applies a 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, evaluates the… | 1,670 | $120 | $191.7K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 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.
33 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0242U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0242U for… | 10,670 | $720 | $7.6M |
| 0326U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0326U only for… | 6,690 | $500 | $3.3M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 8,100 | $170 | $1.4M |
| 81201 | The lab analyst performs the technical lab test to analyze the entire gene sequence for adenomatous polyposis coli, also known as APC. | 4,950 | $150 | $747.5K |
| 81321 | The lab analyst performs the technical lab test to analyze the entire gene sequence for the phosphatase and tensin homolog, or PTEN, gene. | 4,870 | $120 | $574.3K |
| 81120 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for soluble isocitrate dehydrogenase 1 (IDH1), also known as NADP+. | 4,840 | $120 | $570.6K |
| 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… | 4,850 | $70 | $314.9K |
| 81405 | The lab analyst performs the technical lab tests to complete one of the specific genetic analyses listed in this Tier 2, Level 6 molecular pathology code. | 9,300 | $30 | $306.9K |
| 0334U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0334U only for… | 960 | $320 | $304.3K |
| 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… | 4,970 | $60 | $303K |
Showing 1–10 of 33
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
33 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 0242U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0242U for… | 1 | 10 | 10,670 | $720 | $7.7M |
| 0326U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0326U only for… | 1 | 10 | 6,690 | $500 | $3.3M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 10 | 50 | 500 | $160 | $1.1M |
| 81405 | The lab analyst performs the technical lab tests to complete one of the specific genetic analyses listed in this Tier 2, Level 6 molecular pathology code. | 3 | 10 | 470 | $20 | $670.1K |
| 81120 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for soluble isocitrate dehydrogenase 1 (IDH1), also known as NADP+. | 1 | 10 | 4,840 | $120 | $569.3K |
| 81201 | The lab analyst performs the technical lab test to analyze the entire gene sequence for adenomatous polyposis coli, also known as APC. | 1 | 10 | 2,250 | $180 | $423.6K |
| 81400 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 1 molecular pathology code. | 3 | 10 | 1,430 | $10 | $379.6K |
| 81321 | The lab analyst performs the technical lab test to analyze the entire gene sequence for the phosphatase and tensin homolog, or PTEN, gene. | 2 | 10 | 2,420 | $90 | $360.6K |
| 81404 | The lab analyst performs the technical lab tests to complete one of the specific genetic analyses listed in this Tier 2, Level 5 molecular pathology code. | 3 | 10 | 620 | $50 | $304.8K |
| 0334U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0334U only for… | 1 | 10 | 960 | $320 | $304.2K |
Showing 1–10 of 33
Other providers in the same ZIP code as Guardant Health, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Genomic Health, Inc. | CA | Clinical Medical Laboratory | $96.8M | $96.6M |
| County Of San Mateo | CA | Federally Qualified Health Center (FQHC) | $0 | $53.6M |
| San Mateo County | CA | Community/Behavioral Health Agency | $0 | $48.2M |
| John Kapoor | CA | Internal Medicine Physician | $812.8K | $575.1K |
| Peninsula Procedure Center, LP | CA | Ambulatory Surgical Clinic/Center | $901.9K | $0 |
| Christopher Bonzon | CA | Physical Medicine & Rehabilitation Physician | $253.7K | $0 |
| Chris Threatt | CA | Urology Physician | $197.8K | $0 |
| Bruce Lehnert | CA | Podiatrist | $189.1K | $0 |
| Jeffrey Yao | CA | Orthopaedic Hand Surgery Physician | $145.9K | $0 |
| Liam Bosch | CA | Adult Reconstructive Orthopaedic Surgery Physician | $78K | $0 |
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