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NPI 1235363052 · Mason, OH · Clinical Medical Laboratory
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Assurex Health, Inc. is a clinical medical laboratory provider located in Mason, Ohio. This profile covers 4 Medicare and 11 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 | Assurex Health, Inc. |
| Address | 6000 S Mason Montgomery Rd |
| City | Mason |
| State | OH |
| ZIP | 45040 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | May 7, 2009 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $90.3M |
| Medicare | $27.3M |
This lab’s payer mix is skewed toward Medicaid by scale: total Medicare revenue is $27.3M while total Medicaid revenue is $90.3M, indicating Medicaid drives a substantially larger portion of the provider’s business. Both payers show concentrated molecular/genetic testing lines rather than broad clinical lab panels.
Medicare revenue is highly concentrated: the precomputed top-3 Medicare codes account for 100.0% of Medicare revenue, driven primarily by 0345U (87.7% of Medicare revenue), with 81226 (9.4%) and 81225 (2.8%) completing the trio. That mix signals a business model centered on proprietary pharmacogenomic testing (0345U GeneSight psychotropic) plus targeted CYP450 genotyping for medication metabolism.
Competitive standing on Medicare for gene-specific tests is extreme relative to peers: 81226 and 81225 each rank #1 nationally (100th percentile) and are labeled extreme outlier volumes, while 0345U ranks #1 of 1 providers nationally (0th percentile; no national peer volume comparison available). These rankings indicate the provider is a dominant national source for certain CYP2D6/CYP2C19 testing volumes and is effectively the listed source for the proprietary 0345U test.
On Medicaid the top three codes are responsible for 55.2% of Medicaid revenue, with 0345U contributing 20.7%, 81479 contributing 19.4%, and 81381 contributing 15.1%. This concentration shows that Medicaid revenue is split between the same proprietary pharmacogenomic product and higher-volume uncoded or broad molecular pathology and HLA testing lines.
The provider is a dominant in-state player for numerous molecular genetics and pharmacogenetic codes: multiple top Medicaid codes (81479, 81381, 81226, 81225, 81227, 81230, 81291) rank #1 in-state and are annotated as 100th percentile or notably above typical state volume. Several Medicaid codes (including 0345U and 81418) also appear as the only in-state reporting provider (0th percentile; no state peer volume comparison available), reinforcing a strong local market position for these services.
Operational capabilities implied by the code mix include proprietary psychotropic pharmacogenomic testing (0345U GeneSight) plus a broad suite of CYP and multigene pharmacogenetic analyses (81226, 81225, 81227, 81230, 81418) and HLA testing (81381). The presence of high-volume unspecified molecular pathology reporting under 81479 and algorithmic test codes like 81599 suggests both custom/miscellaneous molecular work and multianalyte assays in the service portfolio.
Reimbursement patterns vary sharply by payer and code: Medicare average paid per claim for 0345U is $1324 while Medicaid average paid per claim for the same code is $147, and other codes show similar payer-level payment differentials. These differences imply the provider’s revenue per-test economics are materially influenced by payer mix and by which payer is being billed for high-value proprietary tests.
The provider has an established operational tenure, with NPI enumeration dated 2009-05-07 (~17 years ago), consistent with the organization operating at scale and having time to build the high volumes and market positioning observed across both Medicare and Medicaid claims.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0345U | 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 0345U only for… | 18,120 | $1,320 | $24M |
| 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. | 5,830 | $440 | $2.6M |
| 81225 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for cytochrome P450, family 2, subfamily C, polypeptide 19, also known as CYP2C19. | 2,710 | $290 | $772.6K |
| 81381 | The lab analyst performs the technical lab test for high resolution assessment of human leukocyte antigen genes, called HLA, for one Class I allele or allele group of interest, typically one that is… | 70 | $170 | $11K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 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.
11 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0345U | 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 0345U only for… | 126,630 | $150 | $18.6M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 378,280 | $50 | $17.4M |
| 81381 | The lab analyst performs the technical lab test for high resolution assessment of human leukocyte antigen genes, called HLA, for one Class I allele or allele group of interest, typically one that is… | 386,360 | $40 | $13.5M |
| 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. | 345,420 | $40 | $13.5M |
| 81225 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for cytochrome P450, family 2, subfamily C, polypeptide 19, also known as CYP2C19. | 347,020 | $30 | $10.1M |
| 81418 | Code 81418 describes a test to evaluate a blood or saliva specimen for changes in at least six genes that may impact metabolism of many therapeutic drugs. The test must include CYP2C19 and CYP2D6… | 35,970 | $150 | $5.5M |
| 81227 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for cytochrome P450, family 2, subfamily C, polypeptide 9, also known as CYP2C9. | 344,670 | $10 | $4.5M |
| 81230 | The lab analyst performs the technical lab test to analyze the common variants of the cytochrome P450 family 3 subfamily A member 4 gene (CYP3A4), such as *2, *22. | 334,390 | $10 | $4M |
| 81291 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for 5,10–methylenetetrahydrofolate reductase, also known as MTHFR. | 325,520 | $10 | $1.6M |
| 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. | 109,790 | $10 | $768.5K |
Showing 1–10 of 11
How this provider's Medicaid billing volume and revenue compare to other Ohio providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Ohio median
11 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 0345U | 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 0345U only for… | 1 | 10 | 126,630 | $150 | $18.6M |
| 81418 | Code 81418 describes a test to evaluate a blood or saliva specimen for changes in at least six genes that may impact metabolism of many therapeutic drugs. The test must include CYP2C19 and CYP2D6… | 1 | 10 | 35,970 | $150 | $5.5M |
| 81381 | The lab analyst performs the technical lab test for high resolution assessment of human leukocyte antigen genes, called HLA, for one Class I allele or allele group of interest, typically one that is… | 1 | 10 | 1,140 | $40 | $3.4M |
| 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. | 1 | 10 | 80 | $40 | $2.7M |
| 81225 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for cytochrome P450, family 2, subfamily C, polypeptide 19, also known as CYP2C19. | 1 | 10 | 90 | $30 | $2M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 1 | 10 | 760 | $50 | $2M |
| 81227 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for cytochrome P450, family 2, subfamily C, polypeptide 9, also known as CYP2C9. | 1 | 10 | 260 | $10 | $1.5M |
| 81230 | The lab analyst performs the technical lab test to analyze the common variants of the cytochrome P450 family 3 subfamily A member 4 gene (CYP3A4), such as *2, *22. | 1 | 10 | 260 | $10 | $1.4M |
| 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. | 1 | 10 | 109,790 | $10 | $750K |
| 81291 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for 5,10–methylenetetrahydrofolate reductase, also known as MTHFR. | 1 | 10 | 140 | $10 | $282.4K |
Showing 1–10 of 11
Other providers in the same ZIP code as Assurex Health, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Queen City Hospice, LLC | OH | Community Based Hospice Care Agency | $0 | $61.1M |
| Mira Precision Health, Inc | OH | Clinical Medical Laboratory | $313.2K | $15M |
| Amazing Smiles Dental, LLC | OH | General Practice Dentistry | $0 | $12.1M |
| Luxottica Of America Inc. | OH | Point of Service | $0 | $7.7M |
| Elizabeth Uhlenhake | OH | Dermatology Physician | $966.3K | $0 |
| Samir Patel | OH | Dermatology Physician | $936.5K | $0 |
| Southwest Ohio Pain Management LLC | OH | Ambulatory Surgical Clinic/Center | $661.3K | $0 |
| City Of Mason Ohio | OH | Ambulance | $308.9K | $292.7K |
| Edward Meier | OH | Ophthalmology Physician | $339.3K | $0 |
| Nathan Weir | OH | Dermatology Physician | $245.3K | $0 |
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