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NPI 1629407069 · Madison, WI · Clinical Medical Laboratory
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Exact Sciences Laboratories, LLC is a clinical medical laboratory provider located in Madison, Wisconsin. This profile covers 1 Medicare and 40 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 | Exact Sciences Laboratories, LLC |
| Address | 145 E Badger Rd Ste 100 |
| City | Madison |
| State | WI |
| ZIP | 53713 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | November 6, 2013 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $299.3M |
| Medicaid | $276.5M |
EXACT SCIENCES LABORATORIES, LLC is effectively a high-volume clinical molecular diagnostics operation: the provider's Medicare billing is dominated by 81528 (600.4K claims, $499 avg paid/claim, $299.6M revenue) and its Medicaid billing is likewise dominated by 81528 (977.3K claims, $283 avg paid/claim, $276.6M revenue). The 81528 description indicates stool‑DNA testing with real‑time amplification and algorithmic analysis for colorectal cancer screening, so the business appears centered on a single, high-throughput diagnostic assay rather than diversified outpatient services.
Revenue concentration is extreme for both payers: precomputed metrics show the top three Medicare codes account for 100.0% of Medicare revenue and the top three Medicaid codes account for 100.0% of Medicaid revenue. This indicates that reimbursement and volume for a very small set of codes—principally 81528—drive nearly all reported payer income for this NPI.
The provider is effectively dual‑payer in scale but concentrated in the same product line across payers: total Medicare revenue is $299.3M while total Medicaid revenue is $276.5M, so Medicare is slightly larger in nominal dollars but both payers are substantial and roughly comparable. Despite the two‑payer mix, the underlying service billed is the same molecular test, so payer diversification does not materially diversify clinical service risk.
Competitive standing for the flagship code is leading in available peer comparisons: 81528 ranks #1 of 4 providers nationally for Medicare (100th percentile; labeled "typical, unremarkable volume for this code") and #1 of 2 providers in‑state for Medicaid (100th percentile; labeled "typical, unremarkable volume for this code"). In plain terms, the provider is the top biller for this test in the measured peer sets, but reported volume behavior is characterized by the data source as typical rather than an outlier.
Payer reimbursement per unit differs markedly: Medicare reports an average paid per claim of $499 for 81528 versus $283 for the same code on Medicaid. Although Medicaid shows a lower avg paid/claim, Medicaid claim volume for 81528 is higher (977.3K claims) than Medicare claim volume (600.4K claims), which contributes to the similar aggregate revenue levels reported across payers.
Medicaid billing includes a long tail of low‑revenue outpatient and preventive codes, indicating modest ancillary clinical billing activity beyond the core lab test. Examples include 99213 (2K claims, $112.1K revenue; ranks #446 of 1755 in‑state, 75th percentile) and 99214 (1.2K claims, $93.7K revenue; ranks #494 of 1628 in‑state, 70th percentile), each contributing 0.0% to total Medicaid revenue but showing the provider does submit routine E&M and preventive codes at low volume.
The provider has an established administrative presence: the NPI was enumerated on 2013-11-06 (~13 years ago), consistent with the sustained high claim volumes reported for the flagship test across both payers. Tenure of roughly a decade supports the interpretation that these volumes reflect an ongoing operational program rather than a short‑term spike.
The extreme reliance on a single clinical product line creates concentrated policy and market exposure: because the top codes account for 100.0% of revenue by payer and the business centers on 81528, changes in coverage policy, reimbursement rates, or competitive substitution for that test would disproportionately affect this provider's Medicare and Medicaid revenue. Monitoring payer coverage updates, unit pricing, and claim volume trends for 81528 is therefore the highest‑priority risk/monitoring signal for analysts.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81528 | The lab analyst uses a stool sample and performs the technical lab tests for a fecal hemoglobin test and for real time amplification of 10 DNA markers. The lab analyst then carries out an algorithmic… | 600,420 | $500 | $299.6M |
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 |
|---|---|---|---|---|---|
| 81528 | 1 | 10 | 600,420 | $500 | $299.3M |
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.
40 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81528 | The lab analyst uses a stool sample and performs the technical lab tests for a fecal hemoglobin test and for real time amplification of 10 DNA markers. The lab analyst then carries out an algorithmic… | 977,300 | $280 | $276.6M |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 2,000 | $60 | $112.1K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 1,170 | $80 | $93.7K |
| 0241U | N/A | 220 | $140 | $31.6K |
| 99203 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider… | 260 | $80 | $21.9K |
| 99204 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider… | 90 | $130 | $11.3K |
| 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… | 110 | $100 | $10.7K |
| 90460 | In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age. | 200 | $30 | $6.5K |
| 99394 | The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17. | 60 | $90 | $5.1K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 50 | $80 | $3.8K |
Showing 1–10 of 40
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
40 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81528 | The lab analyst uses a stool sample and performs the technical lab tests for a fecal hemoglobin test and for real time amplification of 10 DNA markers. The lab analyst then carries out an algorithmic… | 1 | 10 | 489,920 | $280 | $138.4M |
| 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… | 134 | 170 | 720 | $70 | $272.7K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 494 | 1,630 | 270 | $40 | $205.3K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 446 | 1,760 | 250 | $40 | $173.2K |
| 93306 | The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent… | 147 | 150 | 440 | $70 | $131.9K |
| 99391 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 186 | 190 | 370 | $60 | $107.4K |
| 99392 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 171 | 210 | 340 | $60 | $98.9K |
| 99215 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the… | 334 | 350 | 210 | $60 | $95.8K |
| 0241U | N/A | 78 | 100 | 990 | $40 | $92.2K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 144 | 200 | 200 | $60 | $64.2K |
Showing 1–10 of 40
Other providers in the same ZIP code as Exact Sciences Laboratories, LLC, ranked by combined Medicare and Medicaid revenue.
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