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NPI 1235671884 · Pittsburgh, PA · Clinical Medical Laboratory
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Cernostics, Inc. is a clinical medical laboratory provider located in Pittsburgh, Pennsylvania. This profile covers 2 Medicare and 1 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 | Cernostics, Inc. |
| Address | 100 S Commons Ste 245 |
| City | Pittsburgh |
| State | PA |
| ZIP | 15212 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | November 14, 2016 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $44.5M |
| Medicaid | $83.5K |
CERNOSTICS, INC. operates as a specialized clinical medical laboratory focused on proprietary molecular and tissue-based risk stratification assays: its billed Medicare portfolio is dominated by PLA tests 0315U (DecisionDx®–SCC) and 0108U (TissueCypher® Barrett’s Esophagus Assay), both manufacturer- or lab-specific algorithmic diagnostics used to stratify cancer risk from biopsy specimens. The code mix indicates a business model centered on high-complexity, high-value diagnostic assays rather than broad routine laboratory services, consistent with a lab commercializing proprietary oncology diagnostics.
Medicare revenue is extremely concentrated: the precomputed top-3 codes account for 100.0% of Medicare revenue, with 0315U reporting $32M in revenue (71.8% of this provider's total Medicare revenue) from 5K claims at an average paid $6379/claim and 0108U reporting $12.6M (28.2% of Medicare revenue) from 2.6K claims at an average paid $4851/claim. This concentration shows the provider’s Medicare performance depends almost entirely on a very small number of high-revenue PLA codes.
On the Medicaid side the provider is effectively single-product: total Medicaid revenue is $83.5K and 0108U alone accounts for $83.3K (100.0% of this provider's total Medicaid revenue) from 683 claims at an average paid $122/claim. Medicaid billing is narrowly focused on the TissueCypher assay, indicating either much lower Medicaid uptake or substantially lower reimbursement per test compared with Medicare.
The overall payer mix is heavily Medicare-dominated: lifetime Medicare revenue of $44.5M dwarfs lifetime Medicaid revenue of $83.5K, making this provider effectively single-payer by scale with Medicare as the overwhelmingly primary revenue source. Analysts should treat Medicaid activity as marginal relative to the Medicare business when modeling revenue or utilization trends.
Competitive standing for the Medicare PLA codes is characterized by sole reporting in the available datasets: both 0315U and 0108U are listed as rank #1 of 1 providers nationally with a note that there is "no national peer volume comparison available." This suggests CERNOSTICS is the only or principal national biller for these specific PLAs in the data, limiting the ability to benchmark against peer volumes but indicating a unique market position for those proprietary tests.
State-level competitive positioning for Medicaid billing of 0108U likewise shows rank #1 of 1 providers in-state (with no state peer volume comparison available), implying the lab is the only in-state reporter of this PLA to Medicaid in the dataset and reinforcing its role as a localized sole-source for TissueCypher Medicaid claims.
Reimbursement profile differences between payers are stark: Medicare averages for the two leading PLAs are $6379/claim (0315U) and $4851/claim (0108U), whereas the Medicaid average for 0108U is $122/claim. This divergence points to material payer-policy and rate disparities that likely affect margin and test adoption dynamics across public payers.
The provider’s NPI was enumerated on 2016-11-14 (~10 years ago), indicating roughly a decade of billing history under this identifier; combined with concentrated PLA revenue, this tenure is consistent with a laboratory that has commercialized a small portfolio of specialized tests and sustained billing activity since enumeration.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0315U | 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 0315U for… | 5,010 | $6,380 | $32M |
| 0108U | 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 0108U for the… | 2,590 | $4,850 | $12.6M |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0108U | 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 0108U for the… | 680 | $120 | $83.3K |
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 0108U | 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 0108U for the… | 1 | 10 | 680 | $120 | $83.5K |
Other providers in the same ZIP code as Cernostics, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Christian Home Healthcare | PA | In Home Supportive Care Agency | $0 | $13.7M |
| West Penn Allegheny Health System Inc. | PA | General Acute Care Hospital | $0 | $10.8M |
| West Penn Allegheny Health System Inc. | PA | Mental Health Clinic/Center (Including Community Mental Health Center) | $0 | $8.6M |
| Thierry Verstraeten | PA | Ophthalmology Physician | $894.3K | $45K |
| Robert Lewen | PA | Ophthalmology Physician | $383.8K | $1.1K |
| Athanasios Colonias | PA | Radiation Oncology Physician | $324.7K | $0 |
| Paul Klepchick | PA | Diagnostic Radiology Physician | $146.7K | $95.6K |
| Mikhail Chilingaryan | PA | Internal Medicine Physician | $240.2K | $0 |
| Sameer Jain | PA | Orthopaedic Surgery Physician | $198.5K | $0 |
| Brett Nielson | PA | Diagnostic Radiology Physician | $180.4K | $760 |
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