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NPI 1710253596 · Hummelstown, PA · Clinical Medical Laboratory
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Pacific Edge Diagnostics Usa Ltd. is a clinical medical laboratory provider located in Hummelstown, Pennsylvania. This profile covers 3 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 | Pacific Edge Diagnostics Usa Ltd. |
| Address | 1214 Research Blvd |
| City | Hummelstown |
| State | PA |
| ZIP | 17036 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | March 27, 2012 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $6.7M |
| Medicaid | $119.9K |
This provider’s Medicare footprint is the primary revenue source: total Medicare revenue is $6.7M versus total Medicaid revenue of $119.9K, indicating Medicare dominates the payer mix for PACIFIC EDGE DIAGNOSTICS USA LTD. The disparity in scale shows the practice operates largely as a Medicare-focused laboratory service rather than a balanced Medicare/Medicaid provider.
Medicare revenue is highly concentrated in a very small set of codes: the precomputed top 3 Medicare codes account for 100.0% of this provider's total Medicare revenue, with 0012M representing 68.0% and 0013M representing 28.7% of Medicare dollars while 0363U contributes 3.4%. This level of concentration suggests business risk is concentrated in a few high-volume assays rather than a broad test mix.
The code mix and taxonomy point to a specialized molecular diagnostics operation: the provider’s taxonomy is Clinical Medical Laboratory and one of the top Medicare codes, 0363U, is explicitly the PLA Cxbladder™ Triage test that evaluates gene expression for urothelial (bladder) cancer. The prominence of 0363U alongside two high-volume codes listed as 0012M and 0013M (no description available) suggests operations are centered on branded or proprietary laboratory assays rather than general clinical lab testing.
On Medicaid the provider’s revenue is also narrowly concentrated: the precomputed top 3 Medicaid codes account for 100.0% of Medicaid revenue, with 0012M making up 53.9% ($64.5K from 750 claims at $86 avg paid/claim) and 0363U making up 46.1% ($55.1K from 76 claims at $725 avg paid/claim). This demonstrates that Medicaid billing mirrors Medicare’s focus on a very small set of tests, though claim volumes and payer-specific average payments differ by code.
Competitive standing is limited to sole-reporter status in available comparisons: the top Medicare codes are listed as rank #1 of 1 providers nationally with a 0th percentile and no national peer volume comparison available, and the Medicaid top codes are rank #1 of 1 in-state with a 0th percentile and no state peer volume comparison available. Those rank and percentile values indicate this entity is the only reporting source for these codes in the comparison sets rather than being benchmarked against a larger peer group, which restricts conventional peer-based benchmarking.
Average paid-per-claim patterns differ markedly between payers and codes: for Medicare the top codes show average paid/claim of $745 for 0012M, $744 for 0013M, and $742 for 0363U (Medicare claim counts: 6.2K, 2.6K, and 305 respectively), whereas Medicaid shows $86 avg paid/claim for 0012M (750 claims) and $725 avg paid/claim for 0363U (76 claims). These exact payment figures suggest materially different reimbursement levels by payer and code that could influence payer contracting or utilization management strategies.
The provider has an established operational tenure: NPI enumeration date is 2012-03-27 (~14 years ago), indicating this Clinical Medical Laboratory has been active for over a decade. Despite that longevity, the billing profile shows a narrow test portfolio concentrated in proprietary molecular assays rather than a broad array of routine laboratory services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0012M | N/A | 6,160 | $750 | $4.6M |
| 0013M | N/A | 2,600 | $740 | $1.9M |
| 0363U | 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 0363U only for… | 310 | $740 | $226.3K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
3 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 0012M | 1 | 10 | 6,160 | $740 | $4.6M |
| 0013M | 1 | 10 | 2,600 | $740 | $1.9M |
| 0363U | 1 | 10 | 310 | $740 | $226.4K |
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 |
|---|---|---|---|---|
| 0012M | N/A | 750 | $90 | $64.5K |
| 0363U | 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 0363U only for… | 80 | $730 | $55.1K |
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 0012M | N/A | 1 | 10 | 750 | $90 | $64.8K |
| 0363U | 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 0363U only for… | 1 | 10 | 80 | $730 | $55.1K |
Other providers in the same ZIP code as Pacific Edge Diagnostics Usa Ltd., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Firetree, Ltd. | PA | Substance Abuse Rehabilitation Facility | $0 | $24.7M |
| Todd Fisher | PA | Family Medicine Physician | $221.3K | $0 |
| Gary Kirman | PA | Optometrist | $44.4K | $0 |
| Natasha Romanoski | PA | Physical Medicine & Rehabilitation Physician | $39.3K | $0 |
| Weibin Shi | PA | Physical Medicine & Rehabilitation Physician | $26.4K | $0 |
| John Pantalone | PA | Chiropractor | $18.8K | $0 |
| Sharon Hattrick | PA | Clinical Psychologist | $14.8K | $0 |
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