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NPI 1326097833 · Saint Cloud, MN · Clinical Medical Laboratory
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Centracare Health Systems is a clinical medical laboratory provider located in Saint Cloud, Minnesota. This profile covers 217 Medicare and 148 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 | Centracare Health Systems |
| Address | 1406 6th Ave North |
| City | Saint Cloud |
| State | MN |
| ZIP | 56303 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | May 10, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $9.4M |
| Medicare | $1.2M |
CENTRACARE HEALTH SYSTEMS is operating as a clinical medical laboratory in SAINT CLOUD, MN with an established NPI enumerated 2006-05-10 (~20 years ago). Its lifetime Medicare revenue is $1.2M while lifetime Medicaid revenue is $9.4M, so Medicaid is the larger revenue source on file for this entity. This payer mix signals the operation serves a high volume of state-covered patients alongside a modest national Medicare footprint.
Revenue concentration on Medicare is meaningfully focused: the precomputed top three Medicare codes account for 28.5% of this provider's total Medicare revenue. Those top three appear to be 36415 ($85.3K, 10.5% of Medicare), 80048 ($75.1K, 9.3% of Medicare), and 80061 ($70K, 8.7% of Medicare), which indicates a significant share of Medicare dollars come from routine specimen collection and basic chemistry/lipid panels.
Medicaid revenue is highly concentrated: the precomputed top three Medicaid codes account for 51.3% of this provider's total Medicaid revenue. The dominant Medicaid drivers are U0003 ($2.9M, 36.0% of Medicaid), U0005 ($802K, 9.9% of Medicaid), and 82306 ($436.2K, 5.4% of Medicaid), showing that a majority of Medicaid dollars are generated by high-volume SARS‑CoV‑2 molecular testing plus vitamin D testing.
The code mix reflects a full-service clinical laboratory with both high-volume routine testing and specialized diagnostics. High-claim routine codes such as 36415 (10.7K claims), 80048 (9.4K claims), 80061 (5.4K claims), 80053 (3.5K claims), 85025 (4.1K claims), and 83036 (4.2K claims) indicate heavy throughput for blood draws and common chemistry/hematology panels, while substantial volumes in molecular/infectious codes (U0003, U0005, 87635) and anatomic pathology/cytology codes (88305, 88142) show capability in molecular diagnostics and pathology services.
Nationally, the provider posts unusually high percentile ranks on many routine Medicare test codes, indicating above-typical national volumes for those services. Examples include 80048 at 99th percentile (rank #90 of 14725; described as notably above typical national volume), 83036 at 99th percentile, and 80053 at 98th percentile; 36415 also ranks #209 of 86467 (100th percentile) and is described in the file as typical but shows very large claim counts, consistent with major specimen-collection throughput.
Within Minnesota Medicaid, CENTRACARE is frequently a dominant statewide provider for select tests. U0003 (42.2K claims, $2.9M; ranks #7 of 274, 98th percentile, described as notably above typical state volume), U0005 (36.5K claims, $802K; ranks #4 of 196, 98th percentile), 82306 (18.2K claims, $436.2K; ranks #1 of 158, 100th percentile, described as an extreme outlier), and 88142 (11K claims, $220K; ranks #1 of 21, 100th percentile) mark the provider as a major in-state source for COVID molecular testing, vitamin D testing, and cytology.
Operationally, the Medicaid claim volumes for molecular testing signal high-throughput diagnostic capacity: U0003 shows 42.2K claims and U0005 shows 36.5K claims, and 87635 and related molecular codes also appear in both payers. These counts, paired with significant Medicaid revenue ($9.4M), suggest the lab runs large-scale infectious disease and screening programs for the state population.
The revenue profile and code concentration create both strengths and exposure: the provider is established (NPI enumerated 2006-05-10 (~20 years ago)) and has built scale in state Medicaid testing (top three Medicaid codes = 51.3% of Medicaid revenue), but the heavy concentration in a few high-volume codes—especially U0003/U0005 on Medicaid—means changes in demand or reimbursement for those specific services could materially affect overall Medicaid revenue.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
217 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 10,660 | $10 | $85.3K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 9,390 | $10 | $75.1K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 5,380 | $10 | $70K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 3,840 | $20 | $61.5K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 1,830 | $30 | $53.2K |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 1,290 | $40 | $51.6K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 610 | $70 | $45.4K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 4,160 | $10 | $37.5K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 3,510 | $10 | $35.1K |
| 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… | 4,090 | $10 | $32.7K |
Showing 1–10 of 217
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 217 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
148 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 42,250 | $70 | $2.9M |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,… | 36,460 | $20 | $802K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 18,180 | $20 | $436.2K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 12,270 | $30 | $404.9K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 12,240 | $30 | $404K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 26,340 | $10 | $368.7K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 12,040 | $20 | $277K |
| 88142 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 11,000 | $20 | $220K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 31,230 | $10 | $218.6K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 19,660 | $10 | $216.2K |
Showing 1–10 of 148
How this provider's Medicaid billing volume and revenue compare to other Minnesota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Minnesota median
148 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 20 | 30 | 340 | $60 | $890.4K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 7 | 270 | 550 | $70 | $254.7K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 25 | 120 | 650 | $50 | $225.2K |
| 87506 | The lab analyst performs a test to detect six to eleven types or subtypes of a pathogen, such as Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia, that cause gastrointestinal… | 1 | 10 | 490 | $200 | $70.7K |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,… | 4 | 200 | 530 | $20 | $68.6K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 29 | 560 | 2,600 | $10 | $62.5K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 7 | 170 | 210 | $30 | $61K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 7 | 160 | 200 | $30 | $60.9K |
| 83655 | The lab analyst performs a test to measure the amount of lead in the patient specimen. A typical aim of the test is to check for lead exposure. | 23 | 90 | 180 | $10 | $56.7K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 16 | 20 | 110 | $70 | $50.9K |
Showing 1–10 of 148
Other providers in the same ZIP code as Centracare Health Systems, ranked by combined Medicare and Medicaid revenue.
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