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NPI 1689607384 · Brisbane, CA · Clinical Medical Laboratory
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Caredx Inc. is a clinical medical laboratory provider located in Brisbane, California. This profile covers 2 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 | Caredx Inc. |
| Address | 3260 Bayshore Blvd |
| City | Brisbane |
| State | CA |
| ZIP | 94005 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | July 8, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $122.5M |
| Medicaid | $16.2M |
CAREDX INC. presents as a highly specialized clinical molecular diagnostics laboratory: its two revenue-driving CPT/HCPCS codes are 81479 (molecular pathology, unspecified) and 81595 (20-gene PCR-based transplant rejection risk test), which together dominate reported billing activity across both payers and align with a lab focused on algorithmic molecular testing rather than broad clinical testing services. The provider’s total Medicare revenue is $122.5M and total Medicaid revenue is $16.2M, indicating a large-scale diagnostic operation concentrated in advanced molecular assays.
Medicare revenue is extremely concentrated: the precomputed top-3 Medicare codes account for 100.0% of Medicare revenue, with 81479 accounting for 79.9% of this provider's total Medicare revenue ($97.9M from 35K claims at $2796 avg paid/claim) and 81595 accounting for 20.1% ($24.7M from 7.8K claims at $3161 avg paid/claim). These two codes alone explain all reported Medicare billing, signaling a narrow, high-revenue service mix.
Medicaid billing is likewise concentrated: the precomputed top-3 Medicaid codes account for 100.0% of Medicaid revenue, driven by 81595 at 64.4% ($10.4M from 18.8K claims at $554 avg paid/claim) and 81479 at 35.6% ($5.8M from 50.1K claims at $115 avg paid/claim). This indicates the provider bills the same specialized assays to Medicaid but with a different claims mix and reimbursement profile than Medicare.
Payer mix is Medicare-dominant: CAREDX’s Medicare revenue ($122.5M) far exceeds its Medicaid revenue ($16.2M), making Medicare the primary commercial scale for this entity rather than a balanced payer portfolio. The disparity suggests operational dependence on Medicare reimbursement and referral pathways for high-revenue molecular tests.
Competitive standing is unusually concentrated by code and geography: 81479 ranks #2 of 80 providers nationally for Medicare (99th percentile; labeled an extreme outlier), and 81479 ranks #1 of 45 providers in-state for Medicaid (100th percentile; extreme outlier), indicating the provider is a major regional—and in some respects national—volume reporter for that molecular pathology bucket. Meanwhile, 81595 shows no peer-volume comparison in national Medicare data (rank #1 of 1 nationally, 0th percentile) and is likewise the sole in-state reporter for Medicaid (rank #1 of 1 in-state, 0th percentile), which points to a unique, low-competition specialty test offering.
Reimbursement and per-claim economics diverge sharply between payers for the same codes: for 81479 Medicare average paid/claim is $2796 versus Medicaid $115, and for 81595 Medicare average paid/claim is $3161 versus Medicaid $554. These large per-claim gaps paired with differing claim volumes (e.g., 35K Medicare claims for 81479 vs 50.1K Medicaid claims) reflect both payer pricing variance and differing utilization patterns that materially affect revenue mix.
The provider has long tenure in Medicare/NPI enrollment (NPI enumerated 2006-07-08, ~20 years ago), and sustained high claim volumes across both Medicare and Medicaid (examples include 35K Medicare claims for 81479 and 50.1K Medicaid claims for 81479, plus 7.8K Medicare and 18.8K Medicaid claims for 81595) consistent with an established, specialty molecular testing business that has scaled over many years. Combined with the narrow code concentration (top codes = 100.0% of revenue), this tenure suggests an entrenched, focused service line rather than a broad-spectrum clinical lab model.
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. | 35,000 | $2,800 | $97.9M |
| 81595 | The lab analyst performs the technical lab tests on a subfraction of peripheral blood using real–time quantitative polymerase chain reaction (PCR) of 20 genes. The lab analyst also carries out an… | 7,800 | $3,160 | $24.7M |
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81595 | The lab analyst performs the technical lab tests on a subfraction of peripheral blood using real–time quantitative polymerase chain reaction (PCR) of 20 genes. The lab analyst also carries out an… | 18,830 | $550 | $10.4M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 50,070 | $120 | $5.8M |
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 |
|---|---|---|---|---|---|---|
| 81595 | The lab analyst performs the technical lab tests on a subfraction of peripheral blood using real–time quantitative polymerase chain reaction (PCR) of 20 genes. The lab analyst also carries out an… | 1 | 10 | 18,830 | $550 | $10.4M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 1 | 50 | 500 | $160 | $1.1M |
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