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NPI 1598260986 · San Diego, CA · Clinical Medical Laboratory
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H&m Molecular Diagnostics, LLC is a clinical medical laboratory provider located in San Diego, California. This profile covers 8 Medicare and 27 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 | H&m Molecular Diagnostics, LLC |
| Address | 3770 Tansy St Ste 101 |
| City | San Diego |
| State | CA |
| ZIP | 92121 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | March 27, 2018 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $13.3M |
| Medicaid | $11.2M |
H&M MOLECULAR DIAGNOSTICS, LLC reports both meaningful Medicare and Medicaid activity, with lifetime Medicare revenue of $13.3M and Medicaid revenue of $11.2M. The NPI was enumerated on 2018-03-27 (~8 years ago), indicating several years of enrollment across both payers rather than a very recent entrant.
Revenue is extremely concentrated by code in both payers: the precomputed top-three codes account for 98.5% of this provider's total Medicare revenue and 98.5% of its total Medicaid revenue. This degree of concentration implies the business is highly dependent on a very small set of COVID-related testing services rather than a broad mix of clinical laboratory lines.
Medicare billing is overwhelmingly driven by K1034 (Provision of covid-19 test, nonprescription self-administered and self-collected use), which generated $12.8M in revenue and represents 94.6% of the provider's Medicare revenue. That K1034 volume places the provider at rank #41 of 30143 providers nationally (100th percentile; extreme outlier, far above typical national volume for this code), signaling national-level dominance for distribution/claiming of this nonprescription self-test code.
Other Medicare codes are present but small by comparison: U0003 ($401.8K, 3.0% of Medicare revenue) and G2023 ($124.9K, 0.9% of Medicare revenue) appear as ancillary NAAT and specimen-collection activity. Both U0003 and G2023 rank in high percentiles among national peers (U0003 rank #44 of 973, 96th percentile; G2023 rank #39 of 465, 92th percentile) but remain minor contributors relative to K1034, indicating the lab performs high-throughput molecular testing and specimen collection but that those services are secondary to its self-test provisioning on Medicare.
Medicaid billing shows a different but related mix: U0003 accounts for $8.3M (73.3% of Medicaid revenue) while G2023 contributes $2.6M (22.8% of Medicaid revenue), together making up the bulk of Medicaid receipts. U0003 ranks #21 of 751 providers in-state (97th percentile) and G2023 ranks #7 of 497 in-state (99th percentile; extreme outlier, far above typical state volume for this code), indicating a very large in-state footprint for high-throughput SARS-CoV-2 NAAT testing and specimen collection under Medicaid.
Competitive standing is asymmetric by payer: the provider is a national outlier for K1034 on Medicare, demonstrating exceptional volume for nonprescription self-test claims, while on Medicaid it is a major in-state player for laboratory NAAT testing and specimen collection (high state percentile ranks for U0003 and G2023). These rank-based signals point to market power in COVID-testing flows (distribution and lab testing) rather than broad diagnostic scope across many clinical laboratory specialties.
The code mix implies core operations centered on COVID testing logistics and processing: heavy throughput for NAAT (U0003, U0005, 87635) and specimen-collection services (G2023), plus extremely large provisioning of nonprescription self-tests (K1034). By contrast, other specialized tests such as pharmacogenomic panel 81418 and multiplex respiratory testing 87637 are present but immaterial to revenue (each represents a fraction of 1% of Medicare revenue), showing limited diversification beyond the COVID-focused service line.
Operational or reporting items worth flagging: several Proprietary Laboratory Analyses (PLA) codes (0032U, 0029U) and multiple other Medicaid codes show nonzero claim counts but $0 avg paid/claim and $0 revenue in the dataset. This pattern could reflect non-reimbursed reporting, contract/billing idiosyncrasies, or data capture issues and merits follow-up if precise payment or contract details are needed for contracting or competitive analysis.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 1,070,720 | $10 | $12.8M |
| 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… | 5,430 | $70 | $401.8K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 5,430 | $20 | $124.9K |
| 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,… | 4,690 | $30 | $117.3K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 1,190 | $50 | $59.5K |
| 81418 | Code 81418 describes a test to evaluate a blood or saliva specimen for changes in at least six genes that may impact metabolism of many therapeutic drugs. The test must include CYP2C19 and CYP2D6… | 20 | $900 | $17.1K |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 100 | $140 | $14K |
| 86409 | The lab analyst performs the technical lab test to analyze the titer (concentration) of neutralizing antibodies in a specimen such as plasma. The level of these antibodies indicates a past infection… | 30 | $80 | $2.5K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.
View: State1 / 2
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.
27 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | 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… | 113,250 | $70 | $8.3M |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 111,980 | $20 | $2.6M |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 5,310 | $50 | $270.7K |
| 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,… | 5,270 | $10 | $52.7K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 290 | $130 | $39.4K |
| 87150 | The lab analyst performs an analysis using amplified DNA or RNA probe technique on a previously isolated and identified organism to categorize the organism more specifically, such as to the taxonomic… | 150 | $150 | $22.5K |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 150 | $140 | $20.9K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 290 | $30 | $7.9K |
| G2024 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen… | 390 | $20 | $6.7K |
| 87500 | The lab analyst performs a test for vancomycin resistance in an infectious organism’s nucleic acid using amplified probe technique. VRE, vancomycin resistant enterococcus, is the most common organism… | 290 | $10 | $4.1K |
Showing 1–10 of 27
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
27 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… | 21 | 750 | 950 | $50 | $890K |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 189 | 250 | 800 | $110 | $625.7K |
| 87633 | The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for… | 211 | 290 | 220 | $210 | $268.3K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 7 | 500 | 530 | $20 | $128.1K |
| 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,… | 105 | 520 | 470 | $10 | $116K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 172 | 1,210 | 420 | $30 | $95.7K |
| G2024 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen… | 33 | 60 | 720 | $20 | $89.1K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 209 | 400 | 330 | $20 | $67.9K |
| 87150 | The lab analyst performs an analysis using amplified DNA or RNA probe technique on a previously isolated and identified organism to categorize the organism more specifically, such as to the taxonomic… | 45 | 80 | 200 | $30 | $62.2K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 119 | 210 | 420 | $10 | $42.4K |
Showing 1–10 of 27
Other providers in the same ZIP code as H&m Molecular Diagnostics, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Precision Toxicology, LLC | CA | Clinical Medical Laboratory | $13.8M | $213.8M |
| Veracyte Labs Sd Corporation | CA | Clinical Medical Laboratory | $75M | $2.4M |
| Sequenom Center For Molecular Medicine LLC | CA | Clinical Medical Laboratory | $0 | $74.1M |
| Biotheranostics, Inc. | CA | Clinical Medical Laboratory | $38.4M | $4M |
| Helix, Inc. | CA | Clinical Medical Laboratory | $169.2K | $22.6M |
| Scripps Health | CA | Clinical Medical Laboratory | $8.9M | $301.7K |
| Biocept, Inc. | CA | Clinical Medical Laboratory | $254.7K | $5.6M |
| Iain Macewan | CA | Radiation Oncology Physician | $2.2M | $0 |
| Prometheus Laboratories Inc. | CA | Clinical Medical Laboratory | $338.8K | $1.6M |
| Neogenomics Laboratories Inc | CA | Clinical Medical Laboratory | $1.8M | $0 |
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