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NPI 1215003603 · Redwood City, CA · Clinical Medical Laboratory
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Genomic Health, Inc. is a clinical medical laboratory provider located in Redwood City, California. This profile covers 5 Medicare and 8 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 | Genomic Health, Inc. |
| Address | 301 Penobscot Drive |
| City | Redwood City |
| State | CA |
| ZIP | 94063 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | November 28, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $96.8M |
| Medicaid | $96.6M |
GENOMIC HEALTH, INC. reports nearly equal scale across the two public payers with Total Medicare revenue of $96.8M and Total Medicaid revenue of $96.6M, indicating the organization derives comparable revenue from both programs rather than being single-payer dependent. This parity suggests payer diversification at the program level but does not speak to product diversification, which is highly concentrated by code.
Revenue concentration is extreme for both payers: the precomputed top-three codes account for 99.5% of this provider's total Medicare revenue and 99.6% of its total Medicaid revenue. Such concentration means a very small set of tests drives almost all billed dollars and overall financial performance is tightly tied to reimbursement and utilization of those specific assays.
A single CPT code, 81519, dominates both books of business: it accounts for $94.7M and 97.8% of Medicare revenue and $95.7M and 99.2% of Medicaid revenue. With that level of share on each payer, 81519 is the primary revenue driver and operational focus for the lab; any coverage, coding, or payment changes affecting 81519 would materially affect overall revenue.
The provider’s code mix and descriptions identify it as a specialized clinical molecular laboratory concentrated on algorithmic, multigene oncology assays. Top CPT/HCPCS entries include proprietary PLA-style tests such as 0329U and 0045U on Medicare and 0047U and 0244U on Medicaid alongside 81519 and 81525, which all indicate next-generation sequencing or RT-PCR–based tumor profiling and recurrence-score products rather than general diagnostic services. This pattern is consistent with a service-line built around proprietary genomic oncology tests and algorithmic reporting.
Competitive standing for the core assays reflects a lack of comparable peer volume in the reported datasets: multiple top codes (81519, 0329U, 0045U, 0244U) are listed as rank #1 of 1 providers nationally or in-state with a parenthetical note of "0th percentile; no national/state peer volume comparison available." That presentation indicates these are lab-specific or limited-distribution assays for which there is no standard peer volume in the available Medicare/Medicaid reporting, rather than conventional multi-laboratory commodity tests.
Ancillary and conventional pathology codes generate only modest revenue relative to the genomic assays. For Medicare, 88360 produced $75.1K (0.1% of Medicare revenue) and is characterized as rank #35 of 5330 providers nationally with "99th percentile; typical, unremarkable volume for this code," while in Medicaid codes such as 81479 ($164.8K, 0.2% of Medicaid revenue) and 88360 ($98.6K, 0.1% of Medicaid revenue) appear as secondary services, representing routine pathology and catch-all molecular procedure billing rather than primary revenue sources.
Operationally and commercially, the provider’s long tenure—NPI enumerated 2006-11-28 (~20 years ago)—combined with an extremely concentrated product mix suggests an established specialty lab that has built sustained volume in a narrow set of oncology assays. That longevity supports institutional experience and market presence for these tests, but it also means strategic performance is likely dependent on maintaining reimbursement and clinical adoption for those legacy assays.
Because the provider’s revenue is overwhelmingly driven by a tiny number of proprietary oncology assays, its financial and contracting profile will be highly sensitive to payer coverage policies, code updates, or competitive introduction of alternative assays. Analysts and contracting teams should treat 81519 and the listed PLA codes (0329U, 0045U, 0047U, 0244U) as mission-critical when evaluating network inclusion, price negotiation, or utilization-management strategies for this entity.
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 |
|---|---|---|---|---|
| 81519 | The lab analyst performs the technical lab tests for 21 genes and carries out an algorithmic analysis using patient data and the lab test results to report a patient recurrence score for breast… | 25,050 | $3,780 | $94.7M |
| 0329U | 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 0329U only for… | 300 | $2,850 | $859.1K |
| 0045U | 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 code 0045U for… | 200 | $3,800 | $763K |
| 81525 | The lab analyst performs the technical lab tests for real time reverse transcription polymerase chain reaction (RT–PCR) of 12 genes using colon tumor tissue. The lab analyst also carries out an… | 140 | $3,020 | $420.1K |
| 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… | 1,030 | $70 | $75.1K |
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.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81519 | The lab analyst performs the technical lab tests for 21 genes and carries out an algorithmic analysis using patient data and the lab test results to report a patient recurrence score for breast… | 46,180 | $2,070 | $95.7M |
| 0047U | 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 code 0047U for… | 390 | $620 | $241.7K |
| 0244U | 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 code 0244U for… | 320 | $600 | $190.2K |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 820 | $200 | $164.8K |
| 84999 | Use 84999 to report chemistry procedures that do not have a specific code. | 380 | $270 | $101.8K |
| 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… | 680 | $150 | $98.6K |
| 81525 | The lab analyst performs the technical lab tests for real time reverse transcription polymerase chain reaction (RT–PCR) of 12 genes using colon tumor tissue. The lab analyst also carries out an… | 30 | $320 | $9.6K |
| 81599 | Use 81599 to report a multianalyte assay with algorithmic analysis, or MAAA test, that does not have a specific Category I code or an administrative code in Appendix O. | 230 | $10 | $2.6K |
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
8 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81519 | The lab analyst performs the technical lab tests for 21 genes and carries out an algorithmic analysis using patient data and the lab test results to report a patient recurrence score for breast… | 1 | 10 | 46,180 | $2,070 | $95.8M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 18 | 50 | 500 | $160 | $1.1M |
| 81599 | Use 81599 to report a multianalyte assay with algorithmic analysis, or MAAA test, that does not have a specific Category I code or an administrative code in Appendix O. | 6 | 10 | 360 | $90 | $275.4K |
| 0047U | 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 code 0047U for… | 2 | 10 | 460 | $590 | $269.1K |
| 0244U | 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 code 0244U for… | 1 | 10 | 320 | $600 | $190.3K |
| 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… | 19 | 60 | 260 | $60 | $69.5K |
| 84999 | Use 84999 to report chemistry procedures that do not have a specific code. | 9 | 10 | 500 | $20 | $59K |
| 81525 | The lab analyst performs the technical lab tests for real time reverse transcription polymerase chain reaction (RT–PCR) of 12 genes using colon tumor tissue. The lab analyst also carries out an… | 1 | 10 | 30 | $320 | $9.6K |
Other providers in the same ZIP code as Genomic Health, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Guardant Health, Inc. | CA | Clinical Medical Laboratory | $174.5M | $19.1M |
| 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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