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NPI 1245494517 · Vista, CA · Clinical Medical Laboratory
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Exagen Inc. is a clinical medical laboratory provider located in Vista, California. This profile covers 23 Medicare and 31 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 | Exagen Inc. |
| Address | 1261 Liberty Way Ste C |
| City | Vista |
| State | CA |
| ZIP | 92081 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | July 15, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $15.7M |
| Medicaid | $4.7M |
EXAGEN INC. operates as a clinical medical laboratory with a clear focus on autoimmune and immunology testing; its proprietary PLA test 0312U (Avise® Lupus) alone generated $11.2M in Medicare revenue and represents 71.2% of the provider’s total Medicare revenue, indicating the lab’s core service line centers on a branded lupus diagnostic. The PLA nature of 0312U (reported only for Avise® Lupus from Exagen, Inc.) explains why this single code dominates Medicare receipts and why national peer volume comparison is not available for that code.
Medicare revenue is highly concentrated: the precomputed top three Medicare codes account for 83.9% of the provider’s total Medicare revenue. Those top contributors include 0312U ($11.2M, 71.2%), 86235 ($1.1M, 7.1%), and 86147 ($869.9K, 5.5%), which together drive the vast majority of the Medicare business and suggest reliance on a narrow set of high-volume autoimmune assays.
On Medicare, EXAGEN shows extreme national concentration for multiple tests and mixed comparability: 0312U ranks #1 of 1 providers nationally (no peer-volume comparison available), 86235 ranks #5 of 746 providers nationally (99th percentile, labeled an "extreme outlier"), and both 86147 and 86146 rank #1 of their peer sets (100th percentile, labeled "extreme outlier"). These rank and percentile signals indicate EXAGEN is a dominant reporter of several specific immunology/autoantibody assays at the national level or is uniquely positioned for proprietary testing.
Medicaid billing is more distributed but still shows concentrated lines: the precomputed top three Medicaid codes account for 45.6% of the provider’s total Medicaid revenue, with 86235 contributing $1M (22.2%), 86146 $556.2K (11.9%), and 0312U $538K (11.5%). This mix indicates the same autoimmune-focused assays drive a substantial share of the Medicaid business, though with a lower single-test concentration than Medicare.
Within California Medicaid, EXAGEN is a leading in-state performer on multiple codes: 86146, 86147, 88184, and 88187 all rank #1 among in-state peers (100th percentile, often called an "extreme outlier"), while 86235 ranks #3 of 125 providers in-state (98th percentile, also labeled an "extreme outlier"). These statewide rank patterns identify EXAGEN as a major provider for antiphospholipid, ENA, and flow cytometry–related services in California’s Medicaid network.
The provider’s public-payer mix favors Medicare by scale: lifetime Medicare revenue is $15.7M versus total Medicaid revenue of $4.7M, so Medicare represents the larger share of reported public-payer income on file. Analysts should treat EXAGEN as Medicare-weighted when modeling public-payer exposure or negotiating Medicare-focused contracts.
EXAGEN’s NPI was enumerated on 2008-07-15 (~18 years ago), indicating a long-standing presence in billing data; combined with the high concentration in a proprietary PLA (0312U) and numerous 100th-percentile ranks, this tenure supports interpretation of the pattern as an established business model focused on specialized autoimmune diagnostics rather than a new entrant.
Multiple codes across both payers are explicitly labeled in the dataset as "extreme outlier" or "notably above typical" (for example, 86235, 86147, 86146, 88184), which makes EXAGEN highly visible for utilization and contracting review. Given the concentration in a few specialized assays (notably 0312U) and the strong in-state dominance on several Medicaid codes, payers and network managers should consider targeted utilization benchmarking, contract terms, or clinical validation pathways specific to autoimmune and flow-cytometry services when engaging with this lab.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
23 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0312U | 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 0312U to be… | 13,590 | $820 | $11.2M |
| 86235 | The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,… | 62,280 | $20 | $1.1M |
| 86147 | The lab analyst performs the technical lab test to analyze for the presence of antibodies to cardiolipin, also called antiphospholipids. Report this code once for each immunoglobulin class the… | 34,800 | $30 | $869.9K |
| 86146 | The lab analyst performs the technical lab test to analyze the sample, such as serum, for the presence of beta 2 glycoprotein I antibody. Report one unit for each antibody. | 34,660 | $30 | $866.6K |
| 83516 | The lab analyst performs the technical immunoassay test involving several steps to detect and measure an analyte of a noninfectious nature. The results show as positive or negative, or in… | 25,720 | $10 | $282.9K |
| 86800 | A lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to thyroglobulin, a protein produced by the thyroid gland that synthesizes, stores, and releases thyroid hormones. | 14,900 | $20 | $238.4K |
| 86376 | The lab analyst performs a technical test to analyze a sample, typically serum, for microsomal antibodies, such as liver, kidney microsomal, called LKM1, or thyroid peroxidase, called TPO, which are… | 14,820 | $10 | $207.5K |
| 86431 | The lab analyst performs a test to evaluate the level of rheumatoid factor, or RF, in patient blood. | 29,530 | $10 | $177.2K |
| 86148 | The lab analyst performs the technical lab steps for an antiphosphatidylserine antibody test, also called APA, to detect antibodies against proteins typically found on cell membranes and platelets.… | 9,550 | $20 | $152.9K |
| 83876 | The lab analyst measures the amount of myeloperoxidase, an enzyme present in neutrophils, in the patient specimen. | 2,750 | $50 | $137.5K |
Showing 1–10 of 23
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 23 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
23 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 0312U | 1 | 10 | 13,590 | $820 | $11.2M |
| 88185 | 31 | 40 | 1,560 | $20 | $139.2K |
| 86235 | 2 | 60 | 1,220 | $20 | $75.7K |
| 86146 | 1 | 30 | 240 | $20 | $45.3K |
| 86147 | 1 | 40 | 200 | $20 | $44.7K |
| 86148 | 1 | 10 | 990 | $20 | $37.6K |
| 83876 | 1 | 10 | 70 | $50 | $34.8K |
| 83520 | 3 | 40 | 230 | $20 | $23.5K |
| 88184 | 3 | 40 | 70 | $70 | $21.4K |
| 82397 | 1 | 10 | 420 | $10 | $19.5K |
Showing 1–10 of 23
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.
31 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 86235 | The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,… | 79,780 | $10 | $1M |
| 86146 | The lab analyst performs the technical lab test to analyze the sample, such as serum, for the presence of beta 2 glycoprotein I antibody. Report one unit for each antibody. | 79,450 | $10 | $556.2K |
| 0312U | 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 0312U to be… | 15,370 | $40 | $538K |
| 86147 | The lab analyst performs the technical lab test to analyze for the presence of antibodies to cardiolipin, also called antiphospholipids. Report this code once for each immunoglobulin class the… | 79,480 | $10 | $476.9K |
| 88184 | The lab analyst performs the technical component of a flow cytometry procedure using a cell surface, cytoplasmic, or nuclear marker to characterize cells and aid clinicians in diagnosing patients… | 25,060 | $10 | $275.6K |
| 88187 | The clinician, typically a pathologist, interprets flow cytometry results of two to eight markers. | 22,000 | $10 | $264K |
| 83516 | The lab analyst performs the technical immunoassay test involving several steps to detect and measure an analyte of a noninfectious nature. The results show as positive or negative, or in… | 52,050 | $1 | $208.2K |
| 86800 | A lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to thyroglobulin, a protein produced by the thyroid gland that synthesizes, stores, and releases thyroid hormones. | 41,020 | $1 | $164.1K |
| 86431 | The lab analyst performs a test to evaluate the level of rheumatoid factor, or RF, in patient blood. | 78,760 | $1 | $157.5K |
| 83520 | The lab analyst measures the analyte, which is not an infectious agent antibody or infectious agent antigen, by immunoassay. Use 83520 for procedures that have no specific code assigned for the… | 29,790 | $10 | $149K |
Showing 1–10 of 31
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
31 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 0312U | 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 0312U to be… | 1 | 10 | 15,370 | $30 | $533.2K |
| 88185 | The lab analyst performs the technical component of a flow cytometry procedure using cell surface, cytoplasmic, or nuclear markers to characterize cells and aid clinicians in diagnosing patients with… | 1 | 40 | 220 | $140 | $354.7K |
| 82542 | The lab analyst performs the technical lab test to evaluate the specimen for the presence or amount of a nondrug analyte by using column chromatography and possibly mass spectrometry. | 10 | 30 | 170 | $30 | $197.6K |
| 86235 | The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,… | 3 | 130 | 280 | $20 | $85.9K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 1,911 | 2,100 | 1,130 | $1 | $83.5K |
| 88184 | The lab analyst performs the technical component of a flow cytometry procedure using a cell surface, cytoplasmic, or nuclear marker to characterize cells and aid clinicians in diagnosing patients… | 1 | 40 | 240 | $30 | $62.7K |
| 80299 | Use 80299 to report therapeutic drug quantitation procedures that do not have a specific code. | 25 | 60 | 210 | $20 | $60K |
| 86146 | The lab analyst performs the technical lab test to analyze the sample, such as serum, for the presence of beta 2 glycoprotein I antibody. Report one unit for each antibody. | 1 | 40 | 130 | $10 | $41.5K |
| 86147 | The lab analyst performs the technical lab test to analyze for the presence of antibodies to cardiolipin, also called antiphospholipids. Report this code once for each immunoglobulin class the… | 1 | 50 | 130 | $10 | $41.1K |
| 83520 | The lab analyst measures the analyte, which is not an infectious agent antibody or infectious agent antigen, by immunoassay. Use 83520 for procedures that have no specific code assigned for the… | 6 | 130 | 270 | $10 | $26.9K |
Showing 1–10 of 31
Other providers in the same ZIP code as Exagen Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Patrick Linson | CA | Radiation Oncology Physician | $1.4M | $0 |
| Norbert Kased | CA | Radiation Oncology Physician | $1.2M | $0 |
| Hanh Bui | CA | Cardiovascular Disease Physician | $795.6K | $5.4K |
| Aftab Qazi | CA | Family Medicine Physician | $88.7K | $540.6K |
| Eva Lean | CA | Radiation Oncology Physician | $508.8K | $0 |
| Jeanny Rickards | CA | Foot & Ankle Surgery Podiatrist | $454.2K | $0 |
| Lindsey Wilke | CA | Foot & Ankle Surgery Podiatrist | $393.6K | $0 |
| Marc Garber | CA | Physical Therapist | $292.7K | $0 |
| Derek Helton | CA | Hematology & Oncology Physician | $206.8K | $0 |
| Michael Hollstegge | CA | Physical Therapist | $177.3K | $0 |
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