Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Ohio for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Ohio only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Ohio (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Cleveland Diagnostics, Inc. (NPI 1699384412)

Field	Value
Entity Type	Organization
Organization	Cleveland Diagnostics, Inc.
Address	3615 Superior Ave E Ste 4407b
City	Cleveland
State	OH
ZIP	44114
Taxonomy	Clinical Medical Laboratory
NPI Enumerated	July 28, 2020

Payer Source	Total Paid
Medicare	$1.8M
Medicaid	$0

Key Findings

CLEVELAND DIAGNOSTICS, INC. operates as a Clinical Medical Laboratory in CLEVELAND, OH, and its Medicare billing is concentrated in prostate-related, algorithmic and proprietary assays. The top procedures reported are 0359U (IsoPSA®, a Proprietary Laboratory Analyses PLA that returns an algorithmic risk score for prostate cancer), 81599 (multianalyte assay with algorithmic analysis, MAAA), and 84153 (total PSA testing), indicating the lab’s service line is focused on advanced prostate cancer diagnostics rather than broad routine chemistry panels.

Medicare revenue is effectively the provider’s only payer activity on file: total Medicare revenue is $1.8M and there is no Medicaid billing on file. This makes the practice functionally single-payer in the available data, with implications for network exposure and reimbursement sensitivity tied to the Medicare program.

Revenue concentration is extreme within Medicare: the precomputed top-3 codes account for 100.0% of this provider’s total Medicare revenue. Those shares are 0359U 79.0%, 81599 20.5%, and 84153 0.5%, showing most dollars derive from a single proprietary PLA and a secondary algorithmic MAAA rather than routine PSA screening.

Code-level volume and pricing show a high-value, procedure-driven model. The provider reported 2.4K claims for 0359U at $608 avg paid/claim totaling $1.5M revenue, 804 claims for 81599 at $468 avg paid/claim totaling $376.3K revenue, and 524 claims for 84153 at $18 avg paid/claim totaling $9.4K revenue, reflecting that higher-priced algorithmic tests drive almost all Medicare dollars while routine PSA contributes negligible revenue.

Competitive standing is mixed: the provider ranks #1 of 3 nationally for 0359U and #1 of 2 nationally for 81599 (both listed at the 100th percentile) but the documentation characterizes the volumes as "typical, unremarkable" for those codes. That suggests the lab is a leading filer among a very small national cohort for these proprietary/MAAA codes, but the national pools for those specific codes are small and the volumes are not characterized as unusually high by the data labels.

For the common PSA code 84153 the provider ranks #493 of 8151 (94th percentile) while the activity is still labeled "typical, unremarkable volume for this code." This indicates that, although the provider is well above many peers on this ubiquitous code, the absolute Medicare revenue contribution from routine PSA testing is minimal relative to its proprietary assays.

Tenure is relatively recent: the NPI was enumerated on 2020-07-28 (~6 years ago). Given this timeline, the provider established its Medicare billing footprint largely within the last several years, primarily around proprietary and algorithmic prostate diagnostics.

From a business-risk and strategic lens, the provider’s near-total reliance on two proprietary/algorithmic codes (0359U and 81599) for all reported Medicare revenue makes its financial profile sensitive to coverage, coding, or reimbursement changes affecting PLAs and MAAA tests. The absence of Medicaid billing further concentrates exposure to Medicare policy and payer decisions affecting proprietary prostate assays.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
0359U	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 0359U only for…	2,390	$610	$1.5M
81599	Use 81599 to report a multianalyte assay with algorithmic analysis, or MAAA test, that does not have a specific Category I code or an administrative code in Appendix O.	800	$470	$376.3K
84153	The lab analyst performs testing for total prostate specific antigen, PSA, typically on serum or plasma samples using laboratory analyzers. PSA is a protein the prostate gland produces, and…	520	$20	$9.4K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Ohio Distribution

Cleveland Diagnostics, Inc. — 0 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. state median

3 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
0359U	1	10	2,390	$610	$1.5M
81599	1	10	800	$470	$376.2K
84153	16	200	30	$20	$8.1K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Cleveland Diagnostics, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Quest Diagnostics Incorporated	NJ	Clinical Medical Laboratory	$111.2M	$637.7M
Quest Diagnostics Incorporated Md	MD	Clinical Medical Laboratory	$27.3M	$121.8M
Quest Diagnostics Of Pennsylvania, Inc.	PA	Clinical Medical Laboratory	$11.3M	$132.4M
Quest Diagnostics Nichols Institute, Inc.	VA	Clinical Medical Laboratory	$2.3M	$46.9M
Mayo Collaborative Services, Inc	MN	Clinical Medical Laboratory	$6.5M	$39.2M
Quest Diagnostics Nichols Institute	CA	Clinical Medical Laboratory	$5.6M	$39.9M
Quest Diagnostics Clinical Laboratories Inc	TX	Clinical Medical Laboratory	$31M	$8.8M
Associated Clinical Laboratories	PA	Clinical Medical Laboratory	$3.8M	$25.9M
Quest Diagnostics Clinical Laboratories Inc	PA	Clinical Medical Laboratory	$74.6K	$22.7M
Specialty Laboratories Inc	CA	Clinical Medical Laboratory	$90.4K	$16.8M

Nearby Providers

Other providers in the same ZIP code as Cleveland Diagnostics, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
City Of Cleveland	OH	Ambulance	$5.5K	$30.5M
Care Alliance	OH	Federally Qualified Health Center (FQHC)	$0	$15.4M
Mental Health Services For Homeless Persons, Inc.	OH	Case Management Agency	$0	$14.6M
Phi Health, LLC	OH	Air Ambulance	$2.2M	$5.6M
Mary Wall	OH	Diagnostic Radiology Physician	$165.2K	$0
Vincent Ferrini	OH	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	$61.2K	$0

Cleveland Diagnostics, Inc. — Billing Profile & Reimbursement Data

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Cleveland Diagnostics, Inc. — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References