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NPI 1487632998 · Gaithersburg, MD · Clinical Medical Laboratory
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Genedx LLC is a clinical medical laboratory provider located in Gaithersburg, Maryland. This profile covers 44 Medicare and 71 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 | Genedx LLC |
| Address | 205 & 207 Perry Pkwy |
| City | Gaithersburg |
| State | MD |
| ZIP | 20877 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | January 4, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $215.3M |
| Medicare | $4.7M |
GENEDX LLC is primarily a genomic/clinical molecular laboratory: its Medicare and Medicaid top codes are dominated by high-complexity genomic sequencing and array tests (e.g., 81432, 81433, 81460, 81229, 81416, 81415), indicating the business focuses on diagnostic exome/genome sequencing and specialized mitochondrial and chromosomal microarray services rather than routine clinical lab panels. The presence of many full-gene sequence and panel codes suggests an operation built around large-scale molecular testing workflows and payer billing for diagnostic genetic evaluations.
Revenue concentration differs markedly by payer: for Medicare the precomputed top 3 codes account for 57.3% of Medicare revenue, showing a majority concentration in a few high-value genomic codes, while for Medicaid the top 3 codes account for 84.4% of Medicaid revenue, indicating an even heavier dependence on a very small set of services (notably 81416 and 81415). These figures imply the provider’s financial performance is highly sensitive to utilization and reimbursement changes for its top panels.
Payer mix is heavily skewed toward Medicaid by scale: reported lifetime Medicaid revenue is $215.3M versus total Medicare revenue of $4.7M, so Medicaid dominates this provider’s lifetime billing. This suggests GENEDX operates largely as a major Medicaid genetic testing vendor in its state, with Medicare representing a much smaller portion of its business.
GENEDX is a dominant statewide Medicaid player for key codes: 81416 and 81415 rank #1 of 1 providers in-state (0th percentile, no state peer volume comparison available) and 81229 ranks #1 of 2 providers in-state (100th percentile), indicating it is effectively the primary in-state supplier for exome sequencing and CMA services billed to Medicaid. That in-state dominance implies strong contracting or market share within Maryland Medicaid for advanced genetic diagnostics.
On the Medicare side GENEDX shows national leadership for several high-revenue codes: 81432, 81433, 81460, 81465 and several others rank #1 of multiple providers nationally and are described as notably above typical national volume or at the 100th percentile. Those rank/percentile indicators characterize GENEDX as a major national provider for certain specialized genomic panels in Medicare billing, not merely a marginal participant.
Specific codes are statistical outliers or above-typical volumes in national comparisons: codes such as 81432, 81460, 81465, 81435, and several others are labeled as notably above typical national volume or at the 100th percentile, which signals unusually high reporting for those tests relative to peers. For Medicaid, 81416 and 81415 show extremely large claim counts (47K and 64.9K claims respectively) and are unique in-state providers, reinforcing their outlier status within the state.
Tenure-wise, GENEDX has an established presence: its NPI was enumerated on 2006-01-04 (~20 years ago), indicating long-standing participation in Medicare/Medicaid programs and likely operational maturity in providing genomic diagnostic services. That longevity may underpin the provider’s deep Medicaid volumes and national Medicare rankings for specific codes.
The combination of high average paid/claim on select Medicare codes (for example 81440 at $3249 and 81460 at $1240) together with the very large Medicaid claim volumes at lower per-claim payments (e.g., 81416 at $2251 avg and 81415 at $914 avg but with tens of thousands of claims) suggests a business model that captures both high-dollar specialized Medicare work and very high-volume Medicaid contracts. This mix can create different revenue drivers by payer: per-claim intensity for Medicare and claim volume scale for Medicaid.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
44 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81432 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least five genes relating to disorders associated with hereditary breast cancer… | 1,840 | $670 | $1.2M |
| 81433 | (Deleted effective January 1, 2025) | 1,800 | $430 | $772.7K |
| 81460 | The lab analyst performs a genomic sequence panel to evaluate the patient specimen for genetic sequences of the entire mitochondrial genome, which relate to nerve or muscle pathologies such as those… | 510 | $1,240 | $628.7K |
| 81465 | The lab analyst performs a genomic sequence analysis panel to evaluate the entire mitochondrial genome from the patient specimen for large deletions, which are missing sections of DNA, that relate to… | 450 | $910 | $410.4K |
| 81440 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least 100 mitochondrial genes encoded in the nucleus, including 19 specific… | 100 | $3,250 | $311.9K |
| 81229 | The lab analyst performs the technical lab test using comparative genomic hybridization (CGH) microarray, also referred to as chromosomal microarray (CMA) or molecular karyotype performed by… | 200 | $1,130 | $223.9K |
| 81435 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least five genes, which relate to hereditary colon cancer–related disorders.… | 240 | $570 | $134.7K |
| 81436 | – WARNING – Code Deleted 2024‑12‑31 | 240 | $570 | $134.7K |
| 81162 | The lab analyst performs the technical lab test to analyze the entire gene sequence for the BRCA1, DNA repair–associated gene, also called BRCA1; and BRCA2, DNA repair–associated gene, also called… | 80 | $1,790 | $134.1K |
| 81448 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least five peripheral–neuropathy–related genes, such as the eight gene examples… | 190 | $560 | $107.2K |
Showing 1–10 of 44
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 44 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
44 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81432 | 1 | 10 | 1,840 | $670 | $1.2M |
| 81433 | 1 | 10 | 1,800 | $430 | $773K |
| 81460 | 1 | 10 | 510 | $1,240 | $628.6K |
| 81465 | 1 | 10 | 450 | $910 | $410.4K |
| 81440 | 1 | 10 | 100 | $3,250 | $311.9K |
| 81229 | 1 | 10 | 200 | $1,120 | $223.9K |
| 81435 | 1 | 10 | 240 | $570 | $134.7K |
| 81436 | 1 | 10 | 240 | $570 | $134.7K |
| 81162 | 1 | 10 | 80 | $1,790 | $134.1K |
| 81448 | 1 | 10 | 190 | $560 | $107.1K |
Showing 1–10 of 44
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.
71 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81416 | The lab analyst performs an exome gene sequence analysis in a relative of the patient to create a reference exome gene sequence, which the lab analyst can compare to the patient’s exome to evaluate… | 46,990 | $2,250 | $105.8M |
| 81415 | The lab analyst performs an exome gene sequence analysis to look for genetic changes that could account for an unexplained disorder or syndrome in the patient. | 64,910 | $910 | $59.3M |
| 81229 | The lab analyst performs the technical lab test using comparative genomic hybridization (CGH) microarray, also referred to as chromosomal microarray (CMA) or molecular karyotype performed by… | 58,260 | $270 | $15.6M |
| 81408 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 9 molecular pathology code. | 14,790 | $350 | $5.1M |
| 81460 | The lab analyst performs a genomic sequence panel to evaluate the patient specimen for genetic sequences of the entire mitochondrial genome, which relate to nerve or muscle pathologies such as those… | 29,480 | $170 | $5.1M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 16,260 | $200 | $3.2M |
| 81465 | The lab analyst performs a genomic sequence analysis panel to evaluate the entire mitochondrial genome from the patient specimen for large deletions, which are missing sections of DNA, that relate to… | 17,300 | $140 | $2.5M |
| 81470 | The lab analyst performs a genomic sequence panel to evaluate the patient specimen for genetic sequences of at least 60 genes, including the 15 genes that the code descriptor lists, which relate to… | 12,570 | $150 | $1.8M |
| 81407 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 8 molecular pathology code. | 14,800 | $120 | $1.8M |
| 81406 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 7 molecular pathology code. | 22,580 | $80 | $1.8M |
Showing 1–10 of 71
How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland median
71 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81416 | The lab analyst performs an exome gene sequence analysis in a relative of the patient to create a reference exome gene sequence, which the lab analyst can compare to the patient’s exome to evaluate… | 1 | 10 | 46,990 | $2,250 | $105.8M |
| 81415 | The lab analyst performs an exome gene sequence analysis to look for genetic changes that could account for an unexplained disorder or syndrome in the patient. | 1 | 10 | 64,910 | $910 | $59.4M |
| 81229 | The lab analyst performs the technical lab test using comparative genomic hybridization (CGH) microarray, also referred to as chromosomal microarray (CMA) or molecular karyotype performed by… | 1 | 10 | 29,570 | $280 | $8.2M |
| 81460 | The lab analyst performs a genomic sequence panel to evaluate the patient specimen for genetic sequences of the entire mitochondrial genome, which relate to nerve or muscle pathologies such as those… | 1 | 10 | 29,480 | $170 | $5.1M |
| 81408 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 9 molecular pathology code. | 1 | 10 | 7,420 | $340 | $2.6M |
| 81465 | The lab analyst performs a genomic sequence analysis panel to evaluate the entire mitochondrial genome from the patient specimen for large deletions, which are missing sections of DNA, that relate to… | 1 | 10 | 17,300 | $140 | $2.5M |
| 81407 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 8 molecular pathology code. | 1 | 10 | 14,800 | $120 | $1.8M |
| 81470 | The lab analyst performs a genomic sequence panel to evaluate the patient specimen for genetic sequences of at least 60 genes, including the 15 genes that the code descriptor lists, which relate to… | 1 | 10 | 12,570 | $150 | $1.8M |
| 81405 | The lab analyst performs the technical lab tests to complete one of the specific genetic analyses listed in this Tier 2, Level 6 molecular pathology code. | 1 | 10 | 22,130 | $70 | $1.7M |
| 81471 | The lab analyst performs a panel to evaluate the patient specimen for duplication and deletion mutations of at least 60 genes, including the 15 genes that the code descriptor lists, which relate to… | 1 | 10 | 12,860 | $120 | $1.5M |
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Other providers in the same ZIP code as Genedx LLC, ranked by combined Medicare and Medicaid revenue.
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