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NPI 1720279805 · San Diego, CA · Clinical Medical Laboratory
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Scripps Health is a clinical medical laboratory provider located in San Diego, California. This profile covers 240 Medicare and 46 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 | Scripps Health |
| Address | 9535 Waples St |
| City | San Diego |
| State | CA |
| ZIP | 92121 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | August 5, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $8.9M |
| Medicaid | $301.7K |
Taxonomy and service mix: Listed as a Clinical Medical Laboratory, SCRIPPS HEALTH’s Medicare code mix shows extremely high volumes of basic specimen collection and routine chemistry and hematology panels (36415, 80053, 85025, 80061, 84443) alongside significant molecular testing (U0003, U0005, 87635). This combination is consistent with a centralized laboratory operation that handles large-scale phlebotomy, chronic disease monitoring (CMP, lipid, A1C, TSH) and on‑demand infectious disease PCR workflows rather than a low‑volume specialty lab.
Medicare revenue concentration: The provider’s top three Medicare codes (36415, 82306, 80053) account for 29.7% of its total Medicare revenue, with those individual contributions reported as 36415 $697.6K (10.3%), 82306 $684.3K (10.1%), and 80053 $635.8K (9.4%). This level of concentration in a small set of high‑throughput codes highlights dependence on routine blood draws and common panels for a substantial share of Medicare billing.
Medicaid revenue concentration: Medicaid billing is heavily concentrated in a single code set: the top three Medicaid codes account for 73.7% of Medicaid revenue, driven predominantly by U0003 which represents $163.4K or 53.3% of the provider’s Medicaid revenue. The next two Medicaid revenue drivers are 80053 ($32.2K, 10.5%) and 85025 ($30.2K, 9.9%), indicating that Medicaid payments are dominated by COVID PCR services plus routine panels.
Payer mix and scale: Medicare revenue ($8.9M) dwarfs Medicaid revenue ($301.7K), so SCRIPPS HEALTH operates as effectively Medicare‑dominant in scale on fee‑for‑service billing. The disparity suggests strategic exposure and revenue reliance on Medicare beneficiaries and associated outpatient lab orders rather than Medicaid populations.
National competitive standing on Medicare: For multiple high‑volume Medicare codes SCRIPPS ranks at the very top nationally — for example, 36415 ranks #49 of 86467 providers (100th percentile; extreme outlier), 82306 ranks #41 of 12453 providers (100th percentile; extreme outlier), and 80053 ranks #58 of 26416 providers (100th percentile; extreme outlier). Those rankings indicate SCRIPPS is a national volume leader for specimen collection and common lab panels, operating far above typical national volumes for these services.
State competitive standing on Medicaid: By contrast its Medicaid profile shows more typical in‑state volumes: U0003 is ranked #246 of 751 providers in-state (67th percentile; typical, unremarkable volume) and routine panels like 80053 and 85025 sit in the 70s–80s percentiles. This suggests SCRIPPS is a meaningful but not dominant Medicaid lab performer statewide, with COVID PCR activity notable but not leading in California.
Statistical outliers and operational implication: Numerous Medicare codes are labeled as “extreme outlier” or “notably above typical national volume” (examples include 36415, 82306, 80053, 80061, 84443, 85025), which supports the interpretation of a high-throughput laboratory infrastructure and likely economies of scale for routine testing. High percentile ranks across many common tests imply capacity for bulk testing workflows that can influence contracting and network inclusion decisions.
Tenure and market presence: The provider’s NPI was enumerated on 2007-08-05 (~19 years ago), indicating long-standing operation in the market. Combined with persistent high Medicare volumes and specialized molecular billing, this tenure supports a stable, established laboratory business line capable of servicing large ambulatory and inpatient specimen volumes.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
240 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 87,200 | $10 | $697.6K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 23,600 | $30 | $684.3K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 63,580 | $10 | $635.8K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 48,460 | $10 | $630K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 35,810 | $20 | $572.9K |
| 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… | 7,360 | $70 | $537.1K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 57,270 | $10 | $458.2K |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 7,450 | $40 | $297.9K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 29,740 | $10 | $297.4K |
| 81513 | The lab analyst performs the technical lab test on a vaginal fluid specimen for quantitative real–time amplification of RNA markers for three bacterial species listed in the code descriptor, and… | 1,450 | $140 | $202.9K |
Showing 1–10 of 240
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 240 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
240 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87798 | 53 | 110 | 1,340 | $30 | $338.2K |
| U0003 | 11 | 130 | 730 | $70 | $246.4K |
| 86235 | 21 | 60 | 1,220 | $20 | $75.7K |
| U0005 | 12 | 150 | 780 | $20 | $75.1K |
| 87481 | 25 | 100 | 270 | $30 | $72.7K |
| 83521 | 3 | 20 | 90 | $20 | $64.3K |
| 86833 | 1 | 10 | 180 | $270 | $48.9K |
| 86832 | 1 | 10 | 180 | $270 | $48.4K |
| 83970 | 4 | 190 | 160 | $40 | $45.6K |
| 86147 | 20 | 40 | 200 | $20 | $44.7K |
Showing 1–10 of 240
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.
46 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… | 2,370 | $70 | $163.4K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 10,730 | $1 | $32.2K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 10,080 | $1 | $30.2K |
| 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,… | 1,050 | $20 | $17.8K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 2,770 | $10 | $13.8K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 4,450 | $1 | $13.3K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 4,920 | $1 | $9.8K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 4,320 | $1 | $4.3K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 1,670 | $1 | $3.3K |
| 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… | 110 | $20 | $2.1K |
Showing 1–10 of 46
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
46 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… | 246 | 750 | 950 | $50 | $890K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 416 | 1,720 | 1,360 | $10 | $165.3K |
| 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,… | 209 | 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… | 861 | 1,210 | 420 | $30 | $95.7K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 505 | 2,100 | 1,130 | $1 | $83.5K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 274 | 1,360 | 590 | $10 | $74.1K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 175 | 1,110 | 300 | $10 | $70.2K |
| 83880 | The lab analyst measures the amount of natriuretic peptide, a hormone made by heart muscle cells, in the patient specimen. Blood levels of the hormone increase in patients with congestive heart… | 568 | 610 | 1,970 | $10 | $59.5K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 483 | 1,120 | 1,000 | $10 | $58.9K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 256 | 1,610 | 640 | $1 | $53.5K |
Showing 1–10 of 46
Other providers in the same ZIP code as Scripps Health, 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 |
| H&m Molecular Diagnostics, LLC | CA | Clinical Medical Laboratory | $13.3M | $11.2M |
| Helix, Inc. | CA | Clinical Medical Laboratory | $169.2K | $22.6M |
| 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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