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NPI 1720359698 · Irvine, CA · Clinical Medical Laboratory
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Mdxhealth, Inc. is a clinical medical laboratory provider located in Irvine, California. This profile covers 4 Medicare and 13 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 | Mdxhealth, Inc. |
| Address | 15279 Alton Pkwy |
| City | Irvine |
| State | CA |
| ZIP | 92618 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | January 24, 2012 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $24M |
| Medicaid | $797.5K |
MDXHEALTH, INC. is a Clinical Medical Laboratory based in IRVINE, CA with an NPI enumerated 2012-01-24 (~14 years ago), and its billed services are concentrated in molecular and algorithmic prostate cancer assays rather than broad anatomic pathology or routine infectious testing. The top-revenue CPT/HCPCS codes are proprietary laboratory analyses and molecular assays (0047U, 81551, 0339U), consistent with a specialized diagnostics operation focused on genomic and methylation-based prostate cancer tests. A small volume of routine pathology coding (88387) appears but represents a negligible share of reported Medicare revenue.
Medicare billing is highly concentrated: the provider reports $24M in total Medicare revenue with the top three Medicare codes accounting for 100.0% of that Medicare revenue. Those three Medicare codes are 0047U ($13.1M, 54.4%), 81551 ($9M, 37.4%), and 0339U ($2M, 8.1%), indicating almost all Medicare payments to this entity derive from a narrow set of prostate-focused tests. This concentration implies that changes in coverage or pricing for these specific codes would disproportionately affect the provider’s Medicare revenue.
Medicaid billing is also concentrated but on a much smaller dollar scale: total Medicaid revenue is $797.5K and the top three Medicaid codes account for 91.0% of that revenue. The Medicaid mix is dominated by 81551 ($395.4K, 49.6%) and 0047U ($296.6K, 37.2%), with 0339U contributing $33.4K (4.2%), signifying the same prostate diagnostics are the main revenue drivers across public payers. Ancillary molecular or infectious codes appear in the Medicaid roster but together represent single-digit percentages of Medicaid revenue.
MDXHEALTH’s payer mix is heavily weighted toward Medicare by dollars: $24M in Medicare revenue versus $797.5K in Medicaid, making Medicare the overwhelming source of reported public-payer revenue. While Medicaid activity exists, it is less than 5% of the scale of Medicare receipts as reported here, indicating the provider operates effectively as Medicare-dominant in this dataset. Analysts should treat this provider as a specialized lab with public-payer exposure concentrated on one clinical area rather than a broadly diversified public-payer laboratory.
On national competitive standing for its top Medicare assays, MDXHEALTH ranks #1 of 1 providers nationally for 0047U, 81551, and 0339U (0th percentile; no national peer volume comparison available), meaning these PLA/molecular codes have no other national reporters in the dataset for comparison. That reporting pattern positions the provider as the sole national biller for these specific PLA codes in this data, which can reflect proprietary test ownership or exclusive reporting rather than large peer competition. In-state Medicaid rankings show a similar pattern for high-revenue PLA codes—81551 ranks #1 of 1 in-state (0th percentile; no state peer volume comparison available) and 0047U ranks #1 of 2 in-state (100th percentile; typical, unremarkable volume for this code)—indicating limited state-level peer activity for these tests.
Several non-PLA codes on the Medicaid roster display ordinary, mid-range state activity and suggest routine ancillary testing capacity alongside the core prostate assays. For example, 87798 ranks #180 of 395 in-state (55th percentile; typical, unremarkable volume) and 81479 ranks #30 of 45 in-state (34th percentile; typical, unremarkable volume), indicating these are common, not outsized, lines of business compared with peers. The presence of these mid-percentile codes suggests the lab performs some general molecular and infectious testing services in addition to its dominant prostate assay business.
From a payer or contracting perspective, MDXHEALTH’s revenue profile signals concentrated cost exposure in a handful of high-cost, proprietary assays: Medicare top three codes account for 100.0% of Medicare revenue and the Medicaid top three account for 91.0% of Medicaid revenue. This concentration means utilization management or coverage decisions specific to 0047U, 81551, and 0339U would materially alter the provider’s public-payer reimbursement flows. Payers evaluating network or payment terms should therefore focus review and contract levers on these proprietary prostate diagnostics rather than broadly distributed lab services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0047U | 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 code 0047U for… | 3,460 | $3,790 | $13.1M |
| 81551 | The lab analyst performs the technical lab test involving promoter methylation analysis of three genes listed in the code, carries out an algorithmic analysis using patient data and the lab test… | 4,540 | $1,980 | $9M |
| 0339U | 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 0339U for… | 2,630 | $740 | $2M |
| 88387 | The analyst performs all the technical steps to examine a tissue specimen using normal sight, dissect out the part of the specimen needed for testing, and then prepare the tissue for nonmicroscopic… | 30 | $20 | $740 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 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.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81551 | The lab analyst performs the technical lab test involving promoter methylation analysis of three genes listed in the code, carries out an algorithmic analysis using patient data and the lab test… | 2,010 | $200 | $395.4K |
| 0047U | 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 code 0047U for… | 530 | $570 | $296.6K |
| 0339U | 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 0339U for… | 360 | $90 | $33.4K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 400 | $60 | $22.5K |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 230 | $80 | $17.3K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 240 | $40 | $9.9K |
| 88387 | The analyst performs all the technical steps to examine a tissue specimen using normal sight, dissect out the part of the specimen needed for testing, and then prepare the tissue for nonmicroscopic… | 500 | $20 | $9.4K |
| 87900 | The lab analyst measures a patient’s susceptibility or resistance to drugs aimed at a virus. The test predicts the behavior of the phenotype based on comparing patient data to regularly updated… | 100 | $40 | $3.6K |
| 87652 | The lab analyst performs a test to quantify infection with Streptococcus, group A, using nucleic acid probe technique. | 240 | $10 | $2.6K |
| 87500 | The lab analyst performs a test for vancomycin resistance in an infectious organism’s nucleic acid using amplified probe technique. VRE, vancomycin resistant enterococcus, is the most common organism… | 240 | $10 | $2.2K |
Showing 1–10 of 13
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
13 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 30 | 50 | 500 | $160 | $1.1M |
| 81551 | The lab analyst performs the technical lab test involving promoter methylation analysis of three genes listed in the code, carries out an algorithmic analysis using patient data and the lab test… | 1 | 10 | 2,010 | $200 | $395.3K |
| 0047U | 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 code 0047U for… | 1 | 10 | 460 | $590 | $269.1K |
| 87900 | The lab analyst measures a patient’s susceptibility or resistance to drugs aimed at a virus. The test predicts the behavior of the phenotype based on comparing patient data to regularly updated… | 7 | 10 | 2,530 | $60 | $234K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 180 | 400 | 330 | $20 | $67.9K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 125 | 210 | 420 | $10 | $42.4K |
| 0339U | 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 0339U for… | 1 | 10 | 360 | $90 | $33.3K |
| 87653 | The lab analyst performs a test for Streptococcus, group B, using amplified nucleic acid probe technique. The amplified probe provides a rapid means to assess colonization by Streptococcus, group B,… | 80 | 130 | 380 | $10 | $13.8K |
| 87500 | The lab analyst performs a test for vancomycin resistance in an infectious organism’s nucleic acid using amplified probe technique. VRE, vancomycin resistant enterococcus, is the most common organism… | 39 | 60 | 430 | $10 | $12.4K |
| 87640 | The lab analyst performs the technical lab test to look for Staphylococcus aureus nucleic acid using an amplified probe technique. | 67 | 100 | 590 | $10 | $10.7K |
Showing 1–10 of 13
Other providers in the same ZIP code as Mdxhealth, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Biognomics Lab, LLC | CA | Clinical Laboratory Director (Non-physician) | $16.4M | $235.6K |
| Shoreline Diagnostics LLC | CA | Clinical Medical Laboratory | $6.2M | $9.6M |
| Agendia Inc | CA | Clinical Medical Laboratory | $10.2M | $5.1M |
| Cap Diagnostics LLC | CA | Clinical Medical Laboratory | $3.4M | $10.8M |
| Healthquest Esoterics Inc | CA | Clinical Medical Laboratory | $159K | $6.7M |
| Specialty Surgical Center Of Irvine LP | CA | Ambulatory Surgical Clinic/Center | $1.1M | $1.4M |
| Fang Yu | CA | Gastroenterology Physician | $121.8K | $2.1M |
| Emeritus Medical Technology LLC | CA | Clinical Medical Laboratory | $1.9M | $20.8K |
| Sandeep Thakkar | CA | Neurology Physician | $1.4M | $92.5K |
| Kenneth Tokita | CA | Radiation Oncology Physician | $1.3M | $0 |
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.