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NPI 1598173502 · San Diego, CA · Clinical Medical Laboratory
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Derm - Jes Holdings, LLC is a clinical medical laboratory provider located in San Diego, California. This profile covers 1 Medicare and 2 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 | Derm - Jes Holdings, LLC |
| Address | 12340 El Camino Real Ste 500 |
| City | San Diego |
| State | CA |
| ZIP | 92130 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | July 23, 2014 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $7.4M |
| Medicaid | $157.1K |
This provider’s revenue is overwhelmingly Medicare-centered: total Medicare revenue is $7.4M versus total Medicaid revenue of $157.1K, making Medicare the dominant payer by scale for this NPI. The disparity in scale indicates the provider operates primarily in the Medicare reimbursement market rather than as a Medicaid-focused lab.
Medicare billing is extremely concentrated in a single proprietary assay: top 3 Medicare codes account for 100.0% of Medicare revenue and code 0089U alone represents 100.0% of the provider’s Medicare revenue (10K claims, $744 avg paid/claim, $7.4M revenue). This concentration is consistent with a business model built around a single PLA test rather than a broad menu of routine lab services.
Medicaid revenue is also highly concentrated: the top 3 Medicaid codes account for 100.0% of Medicaid revenue, with 0089U generating $134.7K (85.1% of Medicaid revenue; 3.2K claims, $42 avg paid/claim) and 81345 contributing $23.6K (14.9% of Medicaid revenue; 576 claims, $41 avg paid/claim). The Medicaid mix shows the same proprietary melanoma assay as the primary Medicaid driver, supplemented by targeted gene analysis.
Competitive standing on Medicare for the lead test is notable: 0089U ranks #1 of 2 providers nationally and is listed in the 100th percentile, indicating this provider is a top-ranked national reporter for that specific PLA. At the same time the data describes the volume for 0089U as "typical, unremarkable volume for this code," which suggests that while this provider is a top reporter among a very small peer set, the absolute activity is not characterized as unusually high in broader clinical terms.
State-level Medicaid positioning is limited by peer data: 0089U ranks #1 of 1 providers in-state with the note "no state peer volume comparison available," implying the provider is the sole in-state reporter for this code in the dataset but that there is insufficient peer volume context to benchmark competitiveness. For 81345 the provider ranks #3 of 3 providers in-state and the activity is described as "typical, unremarkable volume for this code," indicating modest participation in that targeted gene test within the state.
There is a large payer price differential for the same PLA test: for 0089U the avg paid/claim is $744 on Medicare versus $42 on Medicaid, a gap that materially affects revenue contribution by payer despite comparable clinical activity. That payment spread makes the provider’s revenue highly sensitive to payer mix shifts and to any changes in Medicaid coverage or pricing for proprietary assays.
Code descriptions indicate a specialized molecular dermatology focus: 0089U corresponds to the Pigmented Lesion Assay (PLA) molecular RTqPCR test for melanoma-related gene expression, and 81345 is targeted gene analysis (e.g., TERT promoter). Together these codes point to a clinical medical laboratory that primarily performs proprietary and molecular genetic tests related to dermatologic oncology rather than broad-spectrum clinical lab services.
Operational and business risk arises from the high concentration in a single proprietary assay: with 0089U accounting for 100.0% of Medicare revenue and 85.1% of Medicaid revenue, the provider’s financial performance appears tightly coupled to utilization and reimbursement of that one test. Any payer policy changes, coverage restrictions, or competitive substitution affecting 0089U would likely have an outsized impact on the provider’s revenue profile.
The NPI has been active for an extended period: enumerated on 2014-07-23 (~12 years ago), which suggests the provider has an established billing history and has sustained a focused service line over several years; this tenure supports the interpretation that the observed concentration is an intentional, ongoing business model rather than a transient reporting artifact.
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 |
|---|---|---|---|---|
| 0089U | 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 0089U for the… | 10,000 | $740 | $7.4M |
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 |
|---|---|---|---|---|---|
| 0089U | 1 | 10 | 10,000 | $740 | $7.4M |
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0089U | 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 0089U for the… | 3,210 | $40 | $134.7K |
| 81345 | The lab analyst performs the technical lab test to analyze targeted genes, such as the promotor region for the telomerase reverse transcriptase gene (TERT). | 580 | $40 | $23.6K |
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
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 0089U | 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 0089U for the… | 1 | 10 | 3,210 | $40 | $133.6K |
| 81345 | The lab analyst performs the technical lab test to analyze targeted genes, such as the promotor region for the telomerase reverse transcriptase gene (TERT). | 3 | 10 | 680 | $40 | $46.7K |
Other providers in the same ZIP code as Derm - Jes Holdings, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Tandem Diabetes Care Inc | CA | Durable Medical Equipment & Medical Supplies | $0 | $83M |
| Nikolas London | CA | Ophthalmology Physician | $6.4M | $0 |
| Scripps Health | CA | Ambulatory Surgical Clinic/Center | $2.2M | $0 |
| Specialists Surgery Center Of Del Mar LLC | CA | Ambulatory Surgical Clinic/Center | $1.4M | $0 |
| Manisha Kumar | CA | Rheumatology Physician | $1.1M | $0 |
| Megan Lynch | CA | Rheumatology Physician | $1M | $0 |
| Jeffrey Eaton | CA | MOHS-Micrographic Surgery Physician | $554.9K | $0 |
| Andrew White | CA | Allergy & Immunology Physician | $389.6K | $0 |
| Salvatore Pacella | CA | Plastic Surgery Physician | $341K | $0 |
| Katharine Woessner | CA | Allergy & Immunology Physician | $308.8K | $0 |
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