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NPI 1417915653 · Warrendale, PA · Pharmacy
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Accredo Health Group Inc is a pharmacy provider located in Warrendale, Pennsylvania. This profile covers 9 Medicare and 33 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 | Accredo Health Group Inc |
| Address | 3000 Ericsson Dr |
| City | Warrendale |
| State | PA |
| ZIP | 15086 |
| Taxonomy | Pharmacy |
| NPI Enumerated | May 3, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $130.9M |
| Medicare | $37.8M |
This provider’s revenue footprint is concentrated in Medicaid: reported lifetime Medicaid revenue is $130.9M compared with $37.8M in Medicare, indicating Medicaid is the larger payer relationship for ACCREDO HEALTH GROUP INC. The scale of Medicaid revenue versus Medicare suggests the company operates primarily in channels that serve state-covered specialty drug and home-infusion populations.
Medicare revenue is highly concentrated in a small set of high-volume specialty drug codes: the top 3 Medicare codes by revenue account for 80.1% of this provider’s Medicare revenue, led by J7170 which represents $19.9M (54.6% of Medicare revenue). That concentration is consistent with a specialty pharmacy model focused on a handful of injectable biologics rather than broad primary-care drug dispensing.
On Medicare the provider is a national leader for several specific items: J7170 ranks #1 of 6 providers nationally at the 100th percentile and is described as “notably above typical national volume,” and G0069 ranks #1 of 15 providers (100th percentile) indicating above-typical volume for home administration services. At the same time, some Medicare codes like J7192 show typical participation (rank #2 of 7, 83th percentile), so market dominance is concentrated to specific product lines rather than across all specialty codes.
Medicaid revenue is also heavily concentrated in a few therapies: the top 3 Medicaid codes by revenue account for 61.3% of the provider’s Medicaid revenue, driven primarily by J3285 which alone accounts for $55.3M (42.3% of Medicaid revenue). This pattern—one very large drug specialty plus two additional high-revenue therapies—points to a focused business line serving pulmonary/infusion and immune globulin therapies in the state Medicaid program.
The provider shows operational signs of high-cost, high-touch specialty services on Medicaid: several Medicaid codes have very high average paid amounts per claim (for example J3285 $4292 avg paid/claim, J7686 $3406 avg paid/claim, and J7170 $12926 avg paid/claim), and multiple home-infusion and care-coordination per-diem codes (S9347, S9338, S9379) appear in the top Medicaid contributors. Together these items are consistent with a specialty pharmacy/home infusion operator that manages expensive biologics and delivers associated professional and supply services.
ACCREDO has a dominant in-state presence for many Medicaid line items: multiple codes rank #1 in-state (for example J3285, J7686, J1559, J1569 and numerous supply and home-infusion codes) and several are explicitly labeled as “notably above typical” or an “extreme outlier” (A4221 is a stated extreme outlier, far above typical state volume). This indicates the provider is a leading state-level supplier for infusion supplies and specialty drug dispensing.
There is a striking payer-level pricing and utilization contrast for the same drug code across payers: J7170 appears on both Medicare and Medicaid bill lists but with very different unit economics—on Medicare J7170 shows 523.7K claims at $38 avg paid/claim totaling $19.9M, whereas on Medicaid J7170 shows 824 claims at $12926 avg paid/claim totaling $10.7M. This divergence suggests the provider participates in different billing channels or drug-packaging/administration models across the two payers that materially affect per-claim reimbursement and claim volumes.
The NPI tenure indicates this entity has an established presence in the market: the NPI was enumerated on 2006-05-03 (~20 years ago), which supports interpreting these concentrated, high-volume patterns as the activity of a long-tenured specialty pharmacy rather than a recent entrant.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 523,680 | $40 | $19.9M |
| J7205 | Injection, factor viii fc fusion protein (recombinant), per iu | 2,681,800 | $1 | $5.4M |
| J7195 | Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified | 3,901,540 | $1 | $3.9M |
| J7192 | Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified | 3,705,280 | $1 | $3.7M |
| J7187 | Injection, von willebrand factor complex (humate-p), per iu vwf:rco | 2,910,470 | $1 | $2.9M |
| J7211 | Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. | 401,540 | $1 | $401.5K |
| G0069 | Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's… | 9,900 | $20 | $208K |
| G0068 | Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy… | 1,340 | $30 | $34.9K |
| G0089 | Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the… | 210 | $20 | $4K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 9 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.
33 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J3285 | Injection, treprostinil, 1 mg | 12,890 | $4,290 | $55.3M |
| J7686 | Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg | 3,660 | $3,410 | $12.5M |
| J1559 | Injection, immune globulin (hizentra), 100 mg | 9,260 | $1,340 | $12.4M |
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 820 | $12,930 | $10.7M |
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg | 5,810 | $1,660 | $9.6M |
| J1325 | Injection, epoprostenol, 0.5 mg | 6,740 | $730 | $4.9M |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | 2,900 | $1,690 | $4.9M |
| J1555 | Injection, immune globulin (cuvitru), 100 mg | 2,670 | $1,570 | $4.2M |
| S9347 | Home infusion therapy, uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy (e.g., epoprostenol); administrative services, professional pharmacy services, care… | 14,620 | $280 | $4.1M |
| J7192 | Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified | 1,120 | $2,680 | $3M |
Showing 1–10 of 33
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
33 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J3285 | Injection, treprostinil, 1 mg | 1 | 10 | 7,820 | $4,270 | $33.4M |
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 1 | 10 | 790 | $17,150 | $13.6M |
| J7686 | Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg | 1 | 10 | 3,660 | $3,410 | $12.5M |
| J1559 | Injection, immune globulin (hizentra), 100 mg | 1 | 10 | 4,670 | $1,330 | $6.2M |
| J1325 | Injection, epoprostenol, 0.5 mg | 1 | 10 | 6,740 | $730 | $4.9M |
| J1555 | Injection, immune globulin (cuvitru), 100 mg | 1 | 10 | 2,670 | $1,570 | $4.2M |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | 2 | 10 | 1,490 | $2,430 | $3.8M |
| J7192 | Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified | 1 | 10 | 1,120 | $2,680 | $3M |
| J1575 | Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin | 1 | 10 | 1,890 | $1,580 | $3M |
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg | 1 | 10 | 1,120 | $1,340 | $2.5M |
Showing 1–10 of 33
Other providers in the same ZIP code as Accredo Health Group Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Mircea Coca | PA | Ophthalmology Physician | $1.7M | $55.8K |
| Terrance Krysinski | PA | General Practice Physician | $365.7K | $0 |
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