Loading...
NPI 1720306566 · Lewisville, TX · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Med Fusion, LLC is a clinical medical laboratory provider located in Lewisville, Texas. This profile covers 369 Medicare and 180 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 | Med Fusion, LLC |
| Address | 2501 S State Highway 121 Bus Ste 1100 |
| City | Lewisville |
| State | TX |
| ZIP | 75067 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | May 4, 2010 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $10.1M |
| Medicaid | $4.2M |
MED FUSION, LLC’s Medicare code mix is heavily weighted toward complex hematology/oncology and specialized laboratory diagnostics rather than routine outpatient panels. High-revenue Medicare codes include 88185 (96.3K claims, $18 avg paid/claim, $1.7M revenue), 81450 (1K claims, $693 avg paid/claim, $699.2K revenue), and cytogenetic and protein-marker tests such as 83521 and 86334, indicating the operation performs high-volume flow cytometry, genomic panels, cytogenetics, and protein electrophoresis consistent with a specialty clinical laboratory servicing cancer and blood-disorder testing pathways.
Revenue concentration on Medicare is meaningful: the precomputed top 3 Medicare codes by revenue account for 40.1% of this provider's total Medicare revenue. That concentration, anchored by 88185 and 81450, suggests a reliance on a small set of higher-margin specialized assays to drive a large share of Medicare billing.
On the Medicaid side the provider shows an even higher concentration in a few assays: the top 3 Medicaid codes by revenue account for 49.0% of its total Medicaid revenue. Major Medicaid drivers are 84403 (49.9K claims, $18 avg paid/claim, $897.7K revenue), 88185 (4.9K claims, $99 avg paid/claim, $480.2K revenue), and 84402 (20.6K claims, $16 avg paid/claim, $330.4K revenue), emphasizing large volumes in testosterone testing alongside flow cytometry services for the Medicaid population.
In absolute scale MED FUSION reports Total Medicare revenue: $10.1M and Total Medicaid revenue: $4.2M, so Medicare represents the larger single-payer revenue stream while Medicaid remains a substantial secondary source. This dual-payer footprint means the lab is not effectively single-payer and operates with significant exposure to both Medicare and Medicaid billing streams.
Against national Medicare peers MED FUSION is a dominant outlier on multiple specialized codes: 88185 ranks #2 of 618 providers nationally at the 100th percentile (labeled an "extreme outlier"), 88275 ranks #1 of 72 (100th percentile), and several other codes such as 83521, 86334, and 88184 appear in the 99–100th percentiles. These rankings indicate market-leading national volumes for targeted hematopathology and cytogenetics tests rather than routine lab work.
Within Texas Medicaid volumes the provider is also positioned as a major in-state player on several key assays: 88185 ranks #1 of 13 providers in-state (100th percentile), 86300 ranks #1 of 15 providers in-state (100th percentile), and 84403 ranks #3 of 66 providers in-state (97th percentile). Those standings reflect concentrated dominance for specific tests statewide, notably in flow cytometry and certain tumor-marker assays.
The provider’s portfolio shows repeated labels of high statistical extremity—terms noted in the data such as "extreme outlier" and "notably above typical" appear across many high-volume codes (for example, 88185, 83521, 86334, 88271, and 84165). This pattern signals consistent, outsized billing volumes in specialized diagnostic lines compared with both national Medicare and in-state Medicaid peers, which has operational and contracting implications for payers assessing risk and network value.
MED FUSION’s NPI was enumerated on 2010-05-04 (~16 years ago), indicating an established presence; combined with sustained high volumes on complex assays, the tenure supports the interpretation of a mature specialty laboratory operation that has scaled niche testing services over time. For payers and provider analysts this tenure plus the concentration and ranking signals should guide scrutiny of network agreements, referral relationships, and utilization management for the specific high-impact codes listed above.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
369 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 88185 | The lab analyst performs the technical component of a flow cytometry procedure using cell surface, cytoplasmic, or nuclear markers to characterize cells and aid clinicians in diagnosing patients with… | 96,330 | $20 | $1.7M |
| 81450 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as blood or bone marrow, for DNA and possibly RNA alterations in five to 50 genes known to impact… | 1,010 | $690 | $699.2K |
| 83521 | The lab analyst performs a chemistry test to measure the level of each immunoglobulin light chain, kappa or lambda, in a serum specimen. A common lab method for this test is turbidimetry, which uses… | 28,970 | $20 | $492.6K |
| 86334 | The lab analyst performs immunofixation electrophoresis, typically on the patient’s serum, to diagnose and or monitor monoclonal gammopathies or myeloma, a bone marrow tumor. | 19,390 | $20 | $426.6K |
| 88275 | The analyst performs a molecular cytogenetic test using interphase in situ hybridization and analyzes 100 to 300 cells. Interphase refers to a period of time when a cell is not dividing and… | 6,880 | $50 | $343.8K |
| 84165 | The lab analyst performs the technical lab test to separate and quantitate components of serum protein in a process called serum protein electrophoresis, SPE, or SPEP. The electrophoretic… | 23,690 | $10 | $260.6K |
| 82784 | The lab analyst performs the technical lab test to analyze the concentration of a particular gamma globulin in the specimen. The analyst may test for immunoglobulin A, immunoglobulin D,… | 28,610 | $10 | $257.5K |
| 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. | 24,340 | $10 | $243.4K |
| 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… | 15,030 | $20 | $240.5K |
| 88184 | The lab analyst performs the technical component of a flow cytometry procedure using a cell surface, cytoplasmic, or nuclear marker to characterize cells and aid clinicians in diagnosing patients… | 4,430 | $50 | $239.4K |
Showing 1–10 of 369
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 369 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
369 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87798 | 279 | 300 | 790 | $30 | $265.1K |
| 81450 | 1 | 10 | 30 | $700 | $140K |
| 81279 | 5 | 20 | 270 | $180 | $86.8K |
| 87801 | 104 | 120 | 170 | $70 | $86.5K |
| 86003 | 8 | 10 | 8,740 | $10 | $78.5K |
| 87536 | 6 | 10 | 560 | $80 | $75.8K |
| 86480 | 6 | 30 | 60 | $60 | $61.4K |
| 81445 | 2 | 10 | 100 | $580 | $58.3K |
| 81206 | 1 | 10 | 150 | $160 | $56.8K |
| 83704 | 7 | 10 | 120 | $30 | $50K |
Showing 1–10 of 369
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.
180 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 84403 | The lab analyst performs a test to measure total testosterone, typically in patient serum. | 49,870 | $20 | $897.7K |
| 88185 | The lab analyst performs the technical component of a flow cytometry procedure using cell surface, cytoplasmic, or nuclear markers to characterize cells and aid clinicians in diagnosing patients with… | 4,850 | $100 | $480.1K |
| 84402 | The lab analyst performs a test to measure free testosterone, typically in patient serum. | 20,650 | $20 | $330.4K |
| 82652 | The lab analyst measures the level of vitamin D, 1, 25 dihydroxy, a fat soluble steroid that stimulates calcium absorption in the intestine. Vitamin D, 1, 25 dihydroxy is the hormonally active form… | 11,500 | $20 | $253K |
| 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… | 4,450 | $50 | $213.6K |
| 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. | 50,390 | $1 | $151.2K |
| 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… | 14,950 | $10 | $149.5K |
| 86300 | The lab analyst performs a quantitative test to evaluate the patient’s serum for the cancer tumor antigen CA 15 3, a tumor marker for breast cancer, and a similar marker called CA 27.29. | 13,900 | $10 | $125.1K |
| 82728 | The lab analyst measures the level of ferritin, an important protein composed of about 20 percent iron. Ferritin also acts as an iron reserve in the body, and is present in serum in only minute… | 27,460 | $1 | $109.8K |
| 84270 | The lab analyst performs a test to measure sex hormone binding globulin, or SHBG, typically in patient blood. | 5,740 | $20 | $91.8K |
Showing 1–10 of 180
How this provider's Medicaid billing volume and revenue compare to other Texas providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Texas median
180 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… | 55 | 340 | 400 | $50 | $553.5K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 51 | 150 | 170 | $30 | $302.9K |
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 8 | 20 | 1,370 | $40 | $268.3K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 105 | 290 | 410 | $20 | $225K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 107 | 300 | 410 | $20 | $223.4K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 40 | 150 | 220 | $10 | $177.1K |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 6 | 20 | 80 | $30 | $154K |
| 87522 | A lab tests a patient’s specimen to measure the amount of hepatitis C virus present. This may be referred to as viral load. | 9 | 10 | 760 | $20 | $149.4K |
| 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,… | 141 | 260 | 640 | $20 | $137.2K |
| 80074 | The lab analyst performs an acute hepatitis panel; the panel must include tests for hepatitis A IgM antibody, hepatitis B core IgM antibody, hepatitis B surface antigen, and hepatitis C antibody. | 8 | 40 | 100 | $20 | $137.1K |
Showing 1–10 of 180
Other providers in the same ZIP code as Med Fusion, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Reza Mobarak | TX | Foot & Ankle Surgery Podiatrist | $2.2M | $0 |
| Ameripath Texas, Inc. | TX | Clinical Medical Laboratory | $1.5M | $711.8K |
| Purepath Lab & Therapeutics, LLC | TX | Clinical Medical Laboratory | $2M | $117.9K |
| Holly Mccoy | TX | Family Medicine Physician | $216.4K | $0 |
| Deborah Combs Cantrell | TX | Neurology Physician | $180.4K | $0 |
| Jeffrey Kaplan | TX | Cardiovascular Disease Physician | $155.1K | $0 |
| Latoya Keglovits | TX | Anatomic Pathology & Clinical Pathology Physician | $78.4K | $0 |
| Temekka Leday | TX | Hematology (Pathology) Physician | $74.4K | $0 |
| Sheldon Cho | TX | Pain Medicine (Anesthesiology) Physician | $31K | $26.3K |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.