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NPI 1538543731 · Waltham, MA · Clinical Medical Laboratory
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Exosome Diagnostics, Inc. is a clinical medical laboratory provider located in Waltham, Massachusetts. This profile covers 1 Medicare and 3 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 | Exosome Diagnostics, Inc. |
| Address | 266 2nd Ave # 200 |
| City | Waltham |
| State | MA |
| ZIP | 02451 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | July 17, 2015 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $8.9M |
| Medicaid | $310.6K |
EXOSOME DIAGNOSTICS, INC. operates as a clinical medical laboratory focused on a proprietary molecular diagnostic: Medicare billing is dominated by PLA code 0005U, which describes the ExosomeDx® Prostate (IntelliScore) urinary gene expression panel and algorithmic risk score. The provider reported 12K Medicare claims for 0005U with an average paid/claim of $744 and $8.9M in Medicare revenue, indicating its core service offering is a high-volume, single-test prostate cancer risk assay under a PLA code.
Revenue concentration is extreme on Medicare: the precomputed top 3 Medicare codes account for 100.0% of this provider's total Medicare revenue, and 0005U alone is recorded as 100.0% of Medicare revenue. This indicates Medicare income is effectively monocentric around this single proprietary test rather than a diversified panel of laboratory services.
On Medicaid the top-3 codes also account for 100.0% of Medicaid revenue, but the mix is split: 0005U contributes $234.8K (75.9% of Medicaid revenue) across 2.9K claims at $82 avg paid/claim, while U0003 and U0005 (COVID-19 high-throughput testing codes) together account for the remaining 24.1% ($70.4K and $4.1K respectively). This Medicaid mix shows the lab supplied both its proprietary prostate diagnostic and some pandemic-era PCR testing to state Medicaid patients.
Payer-scale and mix: this provider’s Medicare footprint ($8.9M) far exceeds its Medicaid footprint ($310.6K), making it effectively Medicare-dominant in scale. The absolute figures ($8.9M Medicare vs $310.6K Medicaid) reflect a business model that primarily monetizes proprietary lab testing through Medicare reimbursement while Medicaid contributes a small share of overall revenue.
Competitive standing for 0005U is not comparable to a broader peer group: for Medicare 0005U ranks #1 of 1 providers nationally (0th percentile; no national peer volume comparison available) and for Medicaid 0005U ranks #1 of 1 providers in-state (0th percentile; no state peer volume comparison available). These rankings indicate the dataset contains this provider as the sole reporter for 0005U at the national and state levels, so market-share conclusions versus peers cannot be benchmarked from these data.
Medicaid COVID-related activity is modest and typical: U0003 (high-throughput SARS-CoV-2 PCR) shows 828 Medicaid claims and $70.4K in revenue, ranking #80 of 133 providers in-state (40th percentile; typical, unremarkable volume), while U0005 has 241 claims and $4.1K revenue, ranking #80 of 100 providers in-state (20th percentile; typical, unremarkable volume). These entries suggest routine participation in pandemic testing at volumes that are not exceptional relative to state peers.
Reimbursement differential between payers for the same proprietary test is notable: 0005U averaged $744 paid/claim on Medicare but $82 paid/claim on Medicaid for the same PLA code, reflecting large payer-level payment differences for this test. This gap signals that revenue per-test is heavily contingent on payer mix and that Medicare provides substantially higher per-claim reimbursement for the proprietary assay.
Tenure and operational longevity: the provider’s NPI was enumerated on 2015-07-17 (~11 years ago), indicating it has been an active, billable laboratory entity for about a decade. Combined with the billing profile concentrated on a proprietary PLA test, this suggests an established clinical-laboratory operation built around a single commercial assay with supplemental pandemic testing activity during the COVID-19 period.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0005U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code describes only one unique lab test made by a specific manufacturer or performed by a specific lab. Code 0005U describes the… | 12,010 | $740 | $8.9M |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
1 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 0005U | 1 | 10 | 12,010 | $740 | $8.9M |
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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0005U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code describes only one unique lab test made by a specific manufacturer or performed by a specific lab. Code 0005U describes the… | 2,860 | $80 | $234.8K |
| 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… | 830 | $90 | $70.4K |
| 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,… | 240 | $20 | $4.1K |
How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 80 | 130 | 1,830 | $60 | $974.3K |
| 0005U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code describes only one unique lab test made by a specific manufacturer or performed by a specific lab. Code 0005U describes the… | 1 | 10 | 2,860 | $80 | $235.8K |
| 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,… | 80 | 100 | 1,930 | $20 | $155.5K |
Other providers in the same ZIP code as Exosome Diagnostics, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Jewish Family & Children's Service | MA | Foster Care Agency | $0 | $11.6M |
| Children's Dental Of Waltham, P.C. | MA | General Practice Dentistry | $0 | $7.2M |
| West Suburban Eye Surgery Center LLC | MA | Ophthalmologic Surgery Clinic/Center | $4.9M | $1.2M |
| Quantum Pathology, LLC | MA | Anatomic Pathology & Clinical Pathology Physician | $3.1M | $913.7K |
| Boston Eye Surgery & Laser Center Trust | MA | Ambulatory Surgical Clinic/Center | $2.4M | $67.1K |
| Peter Chang | MA | Ophthalmology Physician | $1.3M | $0 |
| Boston Out-patient Surgical Suites, LLC | MA | Ambulatory Surgical Clinic/Center | $693.9K | $0 |
| Stephen Anesi | MA | Ophthalmology Physician | $550.8K | $0 |
| Geoffrey Van Flandern | MA | Orthopaedic Surgery Physician | $408.1K | $0 |
| Ambika Hoguet | MA | Ophthalmology Physician | $375.6K | $0 |
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