Loading...
NPI 1538131362 · Newtown Square, PA · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Institute For Dermatopathology, Inc. is a clinical medical laboratory provider located in Newtown Square, Pennsylvania. This profile covers 12 Medicare and 4 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 | Institute For Dermatopathology, Inc. |
| Address | 3805 W Chester Pike |
| City | Newtown Square |
| State | PA |
| ZIP | 19073 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | February 6, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $8.3M |
| Medicaid | $635.6K |
The provider’s billed services and code mix identify it as a high-volume dermatopathology/clinical pathology laboratory focused on surgical pathology and specialized stains. Medicare billing is dominated by surgical pathology and ancillary staining/interpretation codes such as 88305 (133K claims, $7.3M revenue), 88312 (4.6K claims, $415.7K revenue), and 88342 (3.4K claims, $268.1K revenue), which aligns with the laboratory model of receiving, processing, staining, and interpreting tissue specimens for pathology diagnosis. These codes represent the technical and professional components typical of a pathology reference lab rather than point-of-care or general outpatient services.
Medicare revenue is highly concentrated: total Medicare revenue is $8.3M and the top 3 Medicare codes account for 95.6% of this provider’s Medicare revenue. In particular, 88305 alone represents $7.3M (87.5% of Medicare revenue), indicating the provider’s Medicare business is overwhelmingly driven by high-volume surgical pathology case interpretation. This concentration implies limited Medicare revenue diversification outside these core pathology services.
Medicaid revenue shows a similarly concentrated pattern but at a much smaller scale: total Medicaid revenue is $635.6K and the top 3 Medicaid codes account for 97.4% of this provider’s Medicaid revenue. On Medicaid, 88305 contributes $522K (83.3% of Medicaid revenue) and 88312 contributes $62.7K (10.0% of Medicaid revenue), reinforcing that the same surgical pathology and special-stain services drive nearly all state-payor activity. The Medicaid book of business is therefore narrowly focused on the same core pathology workflows as Medicare, but represents a modest fraction of Medicare dollars.
Payer mix is Medicare-dominant: Medicare revenue ($8.3M) far exceeds Medicaid revenue ($635.6K), so the provider is effectively a Medicare-first specialist with Medicaid as a smaller secondary payer channel. This imbalance suggests contracting, operational planning, and capacity are likely optimized around Medicare volumes and reimbursement levels rather than Medicaid. Analysts should treat Medicaid as a limited but concentrated complement to a larger Medicare practice.
The provider’s competitive standing is outsized for its principal codes: for Medicare, 88305 ranks #1 of 14580 providers nationally (100th percentile; extreme outlier), while 88312 and 88342 also rank as extreme outliers nationally (ranks #31 and #52, respectively). These national-level rankings indicate a dominant market position for those pathology services and suggest the organization is a major referral hub or centralized laboratory for surgical pathology and immunohistochemical stains at a national scale. For payers, this may mean the provider has negotiating leverage or entrenched referral relationships for these specific services.
State-level competitive signals on Medicaid reinforce local dominance for core codes: in-state, 88305 ranks #5 of 487 providers (99th percentile; extreme outlier) and 88312 ranks #1 of 61 providers in-state (100th percentile; extreme outlier). Those positions point to a strong foothold in the state Medicaid market for high-volume pathology interpretation and specialized staining services, making the provider a leading in-state pathology vendor for Medicaid-covered cases. Payers evaluating network composition should view this provider as a top-shelf supplier for those procedures within the state.
The practice shows operational focus rather than breadth: while a few ancillary codes (for example, 88341 and 88304) appear with notable volumes—88341 ($178.8K Medicare revenue, 99th percentile; notably above typical national volume) and 88304 ($142.6K Medicare revenue, rank #4 nationally; extreme outlier)—many other listed codes (e.g., 88313, 88323, 88321) are at typical or unremarkable volumes. This pattern suggests the organization concentrates resources and capacity on high-throughput surgical pathology casework and a subset of specialty stains/tests, rather than offering a wide, evenly distributed menu of low-volume laboratory services. For payers, that signals predictable, concentrated utilization for claims modeling and network needs.
The provider is long-tenured in the public payer datasets, with NPI enumeration on 2006-02-06 (~20 years ago), which supports an interpretation of sustained specialty operations and established referral relationships. Combined with the extreme outlier rankings and persistent concentration of revenue into a few pathology codes, the tenure suggests operational stability and an entrenched role as a high-volume pathology lab rather than a transient or recently established entrant. Analysts should consider this longevity when assessing contract risk, continuity of service, and historical utilization trends.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
12 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 133,000 | $60 | $7.3M |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 4,620 | $90 | $415.7K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 3,350 | $80 | $268.1K |
| 88341 | The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified… | 2,550 | $70 | $178.8K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 4,460 | $30 | $142.6K |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 290 | $60 | $18.5K |
| 88323 | A qualified provider, typically a pathologist, provides consultation and a report on referred material, such as a tissue block, and prepares and stains slides. A unit of service is the surgical case… | 120 | $90 | $10.6K |
| 88321 | A qualified provider, typically a pathologist, provides consultation and a report on slides prepared elsewhere. A unit of service is the surgical case regardless of the number of slides received. | 90 | $80 | $7.3K |
| 88365 | The lab analyst applies an initial in situ hybridization single probe stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a… | 40 | $70 | $3.1K |
| 88364 | The lab analyst applies an additional in situ hybridization single probe stain on a slide or slides prepared from the same patient specimen as the initial probe stain, such as tumor tissue. Then a… | 40 | $60 | $2.5K |
Showing 1–10 of 12
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 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.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 22,700 | $20 | $522K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 2,410 | $30 | $62.7K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 2,350 | $10 | $25.8K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 580 | $30 | $16.2K |
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
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 5 | 490 | 320 | $40 | $55.9K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 37 | 200 | 130 | $30 | $17.5K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 1 | 60 | 40 | $40 | $11.8K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 4 | 180 | 60 | $10 | $3.5K |
Other providers in the same ZIP code as Institute For Dermatopathology, Inc., ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.