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NPI 1538559919 · Louisville, CO · Clinical Medical Laboratory
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Biodesix, Inc. is a clinical medical laboratory provider located in Louisville, Colorado. This profile covers 5 Medicare and 8 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 | Biodesix, Inc. |
| Address | 919 W Dillon Rd |
| City | Louisville |
| State | CO |
| ZIP | 80027 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | January 23, 2015 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.2M |
| Medicaid | $42.4K |
BIODESIX, INC. is filed under the Clinical Medical Laboratory taxonomy and its top-coded activity centers on advanced oncology diagnostics rather than routine testing. The provider’s leading Medicare codes — 81538 (mass‑spectrometry proteomic prognostic test for lung cancer), 81455 (large genomic panel, 51+ genes), and single‑gene oncology assays such as 81235 (EGFR) — indicate a service mix focused on proteomic and molecular oncology assays and genomic sequencing rather than primary-care laboratory services.
Medicare revenue is highly concentrated: the precomputed top‑3 Medicare codes account for 96.1% of the provider’s total Medicare revenue, with 81538 alone representing 59.6% of Medicare receipts (894 claims, $2814 avg paid/claim) and 81455 contributing 33.1% (488 claims, $2861 avg paid/claim). This concentration around one proteomic prognostic assay and one large genomic panel exposes the provider’s Medicare performance to volume or coverage changes for a very small set of high‑value tests.
Medicaid revenue is also concentrated but to a lesser degree: the top‑3 Medicaid codes represent 69.5% of the provider’s Medicaid revenue. The same core tests appear in Medicaid billing — 81538 (415 claims, $36 avg paid/claim) and 81235 (399 claims, $23 avg paid/claim) — but these lines generate only $42.4K total Medicaid revenue, reflecting much lower average payments under Medicaid for the same or similar services.
The payer mix is effectively Medicare‑dominated: total Medicare revenue of $4.2M dwarfs total Medicaid revenue of $42.4K, indicating BIODESIX’s commercial and Medicare-facing activity drives nearly all billings on file. In practical terms, the business is highly dependent on Medicare reimbursement and volumes rather than state Medicaid volumes or payments.
Competitive standing varies by code and payer. For Medicare, 81538 is listed as #1 of 1 nationally with no national peer volume comparison available, indicating BIODESIX is the sole national reporter in this dataset for that code; 81455 ranks #9 of 36 nationally (77th percentile), signaling an above‑median national presence for large genomic panels; and 81235 ranks #2 of 23 (95th percentile), described as notably above typical national volume for EGFR testing, showing strength in specific oncology molecular assays.
State‑level competitive signals are mixed and often limited by sparse peer counts. On Medicaid, 81538 is #1 of 1 in‑state (no state peer comparison available) while 81235 is #1 of 2 in‑state (100th percentile, labeled typical), and 81479 (unspecified molecular pathology) is #2 of 5 (75th percentile, typical). These rankings suggest BIODESIX occupies a leading position for several specialty molecular tests within its state data pool, but the in‑state sample sizes are small which limits inference about broad market dominance.
The provider shows an unusual payment profile between payers for identical codes: for 81538 the Medicare avg paid/claim is $2814 while the Medicaid avg paid/claim is $36 for the same code (with 894 Medicare claims vs 415 Medicaid claims). A similar pattern appears for 81455 (Medicare avg $2861 vs Medicaid avg $227), illustrating that the same high‑complexity oncology assays generate substantially different revenue outcomes depending on payer, which contributes to the large Medicare/Medicaid revenue gap.
BIODESIX’s NPI tenure (enumerated 2015-01-23, ~11 years ago) indicates it is an established laboratory actor in the dataset. Given its long‑standing enumeration and the concentration in specialized molecular oncology codes, the provider appears positioned as a specialized, mature diagnostic lab whose financial performance in this dataset is highly sensitive to reimbursement and volume trends for a narrow set of advanced oncology assays.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81538 | The lab analyst performs the technical lab steps to evaluate serum using mass spectrometry for eight proteins, including amyloid A. The lab analyst then performs a predictive algorithm using lab test… | 890 | $2,810 | $2.5M |
| 81455 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as tumor tissue or bone marrow, for DNA and possibly RNA alterations in 51 or more genes known to… | 490 | $2,860 | $1.4M |
| 81235 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for epidermal growth factor receptor, also known as EGFR. | 460 | $320 | $145K |
| 81275 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene Kirsten rat sarcoma viral oncogene homolog, also known as KRAS, which occur in exon 2. | 460 | $190 | $86K |
| 81210 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for B–Raf proto–oncogene, serine/threonine kinase, also known as BRAF. | 460 | $170 | $78.4K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.
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.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81538 | The lab analyst performs the technical lab steps to evaluate serum using mass spectrometry for eight proteins, including amyloid A. The lab analyst then performs a predictive algorithm using lab test… | 420 | $40 | $14.9K |
| 81235 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for epidermal growth factor receptor, also known as EGFR. | 400 | $20 | $9.2K |
| 81275 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene Kirsten rat sarcoma viral oncogene homolog, also known as KRAS, which occur in exon 2. | 390 | $10 | $5.4K |
| 81210 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for B–Raf proto–oncogene, serine/threonine kinase, also known as BRAF. | 380 | $10 | $3.8K |
| 81455 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as tumor tissue or bone marrow, for DNA and possibly RNA alterations in 51 or more genes known to… | 20 | $230 | $3.4K |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 520 | $10 | $3.1K |
| 81404 | The lab analyst performs the technical lab tests to complete one of the specific genetic analyses listed in this Tier 2, Level 5 molecular pathology code. | 120 | $10 | $1.7K |
| 81401 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 2 molecular pathology code. | 150 | $10 | $1K |
How this provider's Medicaid billing volume and revenue compare to other Colorado providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Colorado median
8 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81404 | The lab analyst performs the technical lab tests to complete one of the specific genetic analyses listed in this Tier 2, Level 5 molecular pathology code. | 4 | 10 | 140 | $230 | $34.1K |
| 81235 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for epidermal growth factor receptor, also known as EGFR. | 1 | 10 | 260 | $70 | $17.5K |
| 81538 | The lab analyst performs the technical lab steps to evaluate serum using mass spectrometry for eight proteins, including amyloid A. The lab analyst then performs a predictive algorithm using lab test… | 1 | 10 | 420 | $40 | $14.9K |
| 81210 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene for B–Raf proto–oncogene, serine/threonine kinase, also known as BRAF. | 1 | 10 | 250 | $40 | $10.4K |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 2 | 10 | 470 | $30 | $10.4K |
| 81275 | The lab analyst performs the technical lab test to detect the presence of common changes in the gene Kirsten rat sarcoma viral oncogene homolog, also known as KRAS, which occur in exon 2. | 1 | 10 | 390 | $10 | $5.6K |
| 81401 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 2 molecular pathology code. | 3 | 10 | 140 | $40 | $5.4K |
| 81455 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as tumor tissue or bone marrow, for DNA and possibly RNA alterations in 51 or more genes known to… | 1 | 10 | 20 | $230 | $3.4K |
Other providers in the same ZIP code as Biodesix, Inc., ranked by combined Medicare and Medicaid revenue.
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