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NPI 1558672279 · San Carlos, CA · Clinical Medical Laboratory
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Natera, Inc. is a clinical medical laboratory provider located in San Carlos, California. This profile covers 2 Medicare and 61 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 | Natera, Inc. |
| Address | 201 Industrial Rd Ste 410 |
| City | San Carlos |
| State | CA |
| ZIP | 94070 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | June 28, 2010 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $641.5M |
| Medicare | $133.1M |
NATERA, INC. is a Clinical Medical Laboratory based in SAN CARLOS, CA with an NPI enumerated on 2010-06-28 (~16 years ago). Its lifetime billing profile shows materially larger Medicaid receipts (Total Medicaid revenue: $641.5M) than Medicare receipts (Total Medicare revenue: $133.1M), indicating Medicaid is the dominant payer by scale for this entity.
Medicare revenue is highly concentrated: the precomputed top-3 Medicare codes account for 100.0% of the provider's Medicare revenue. The two named Medicare drivers are 81479 (22.5K claims, $3563 avg paid/claim, $80.2M; 60.3% of Medicare revenue) and 0340U (13.8K claims, $3838 avg paid/claim, $52.9M; 39.7% of Medicare revenue), which together represent the entirety of reported Medicare billing.
Natera shows a meaningful national footprint on select Medicare molecular pathology codes: 81479 ranks #5 of 80 providers nationally (95th percentile; notably above typical national volume for this code), signaling substantial national testing volume for non-specific molecular pathology. 0340U is reported as a Proprietary Laboratory Analyses (PLA) code for Signatera™ and ranks #1 of 1 providers nationally (0th percentile; no national peer volume comparison available), indicating this is a proprietary test offered by the lab rather than a distributed national service.
On the Medicaid side Natera's revenue is also concentrated: the precomputed top-3 Medicaid codes account for 75.8% of Medicaid revenue, driven by 81420 (1.2M claims, $256 avg paid/claim, $298.5M; 47.0% of Medicaid revenue), 81408 (453.7K claims, $238 avg paid/claim, $108M; 17.0%), and 81220 (542.3K claims, $138 avg paid/claim, $74.8M; 11.8%). These three codes together form a sizable share of the Medicaid book and point to large-scale, repeatable screening services.
Competitive standing in-state is dominant for many Medicaid codes: Natera ranks #1 of 32 for 81420 (100th percentile; extreme outlier), #1 of 11 for 81408 (100th percentile; extreme outlier), and #1 of 110 for 81220 (100th percentile; extreme outlier), among many other #1 rankings at the state level. This pattern — including many codes flagged as "extreme outlier" or "notably above typical state volume" — indicates market leadership in California Medicaid for prenatal, carrier, and newborn genetic testing panels.
The code mix points to two primary service lines: a high-volume reproductive/genetic testing business (e.g., noninvasive prenatal testing 81420, molecular panels 81408, CFTR 81220 and numerous carrier/newborn screens) and specialized oncology ctDNA and molecular pathology services (0340U Signatera™ and 81479). High claim counts on NIPT and carrier screens (for example 81420 at 1.2M claims) alongside proprietary oncology testing suggest an operational model built on both population-scale screening and higher-priced boutique oncology assays.
Revenue concentration creates exposure to payer policy or coding changes: Medicare revenue is effectively driven entirely by the precomputed top-3 codes (100.0%), and Medicaid relies heavily on its top three codes for 75.8% of Medicaid revenue. Given the reliance on a small set of high-volume codes (and a PLA test unique to this lab), reimbursement or coverage shifts for those specific services could have outsized effects on reported revenue.
Several individual-code statistical labels underscore atypical volumes: multiple Medicaid codes are described as "extreme outlier" or "notably above typical state volume" (for example 81420, 81408, 81220, and many additional Tier 2/level molecular pathology codes), while Medicare 81479 is "notably above typical national volume." These descriptors, together with the listed rank and percentile data, reinforce that Natera operates at far higher volumes than most peers for a focused set of genetic and molecular pathology services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 22,510 | $3,560 | $80.2M |
| 0340U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0340U only for… | 13,780 | $3,840 | $52.9M |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 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.
61 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81420 | The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,… | 1,166,000 | $260 | $298.5M |
| 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. | 453,750 | $240 | $108M |
| 81220 | The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR… | 542,280 | $140 | $74.8M |
| 81443 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least 15 genes, such as the 20 gene examples listed in the code descriptor. The… | 88,980 | $280 | $25.2M |
| 81329 | The lab analyst performs the technical lab test to detect deletions in the survival of motor neuron 1 (SMN1), telomeric, gene and may also analyze the survival of motor neuron 2 (SMN2), centromeric,… | 554,420 | $40 | $19.4M |
| 81161 | The lab analyst performs the technical lab test to analyze specific changes involving deleted, or possibly repeated, nucleotide sequences in the dystrophin gene, also known as the DMD gene. | 440,410 | $40 | $19.4M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 43,620 | $280 | $12.1M |
| 81422 | The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell–free fetal DNA in maternal blood for chromosomal microdeletion(s) associated with conditions such as DiGeorge… | 152,330 | $70 | $10.5M |
| 81361 | The lab analyst performs the technical lab test to detect the presence of specific changes in the hemoglobin, subunit beta (HBB) gene specifically for common variants, such as HbS, HbC, HbE. | 332,680 | $30 | $9M |
| 0340U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0340U only for… | 35,030 | $210 | $7.4M |
Showing 1–10 of 61
How this provider's Medicaid billing volume and revenue compare to other California providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. California median
61 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81420 | The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,… | 1 | 30 | 300 | $260 | $18M |
| 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 | 380 | $230 | $10.8M |
| 0340U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0340U only for… | 1 | 10 | 35,030 | $210 | $7.4M |
| 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… | 3 | 10 | 440 | $500 | $5.3M |
| 81443 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least 15 genes, such as the 20 gene examples listed in the code descriptor. The… | 1 | 10 | 3,040 | $290 | $4.7M |
| 81507 | The lab analyst performs the technical lab tests to detect fetal trisomies 13, 18 and 21 in the maternal plasma during pregnancy. The analyst uses a micro assay technique and carries out an… | 2 | 10 | 10,190 | $280 | $4.5M |
| 81161 | The lab analyst performs the technical lab test to analyze specific changes involving deleted, or possibly repeated, nucleotide sequences in the dystrophin gene, also known as the DMD gene. | 1 | 10 | 3,090 | $40 | $3.5M |
| 81361 | The lab analyst performs the technical lab test to detect the presence of specific changes in the hemoglobin, subunit beta (HBB) gene specifically for common variants, such as HbS, HbC, HbE. | 1 | 10 | 900 | $30 | $1.9M |
| 81220 | The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR… | 1 | 110 | 190 | $140 | $1.6M |
| 81422 | The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell–free fetal DNA in maternal blood for chromosomal microdeletion(s) associated with conditions such as DiGeorge… | 1 | 10 | 3,270 | $60 | $1.5M |
Showing 1–10 of 61
Other providers in the same ZIP code as Natera, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Sutter Bay Medical Foundation | CA | Ambulatory Surgical Clinic/Center | $1.3M | $0 |
| Grace Kim | CA | Endocrinology, Diabetes & Metabolism Physician | $446.8K | $0 |
| Leila Chaychi | CA | Endocrinology, Diabetes & Metabolism Physician | $368.5K | $0 |
| Digestive Care Medical Center Inc | CA | Ambulatory Surgical Clinic/Center | $321.1K | $0 |
| Jaret Butler | CA | Orthopaedic Hand Surgery Physician | $131.4K | $0 |
| David Myers | CA | Integrative Medicine Physician | $43.4K | $0 |
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