Circulogene Theranostics — Billing Profile & Reimbursement Data
NPI 1730558602 · XX · healthcare
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Circulogene Theranostics is a healthcare provider located in Unspecified Location. This profile covers 5 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services. Note: "XX" is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; claims coded under it are grouped and benchmarked here the same way a traditional state would be.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Circulogene Theranostics |
| Address | |
| City | |
| State | XX (Unspecified Location) |
| ZIP | |
| Taxonomy | N/A |
| NPI Enumerated | |
| NPI Deactivated | March 12, 2024 |
(source: CMS Medicare & Medicaid claims data)
Key Findings
Circulogene Theranostics reports $2.3M in lifetime Medicare revenue and has no Medicaid billing on file, making its public payer footprint effectively single‑payer (Medicare) in the available data. The absence of any Medicaid claims suggests Medicaid is not a current revenue source and limits in‑state payer comparisons.
Revenue is highly concentrated in a small set of complex molecular tests: the precomputed top three Medicare codes account for 98.5% of this provider's total Medicare revenue. That concentration indicates the business is narrowly focused on a few high‑value services rather than a broad portfolio of routine billing codes.
The dominant code is 81455, which generated $1.7M in revenue (75.9% of this provider's Medicare revenue) across 599 claims at $2857 avg paid/claim. 81194 produced $304.3K (13.5%) with 599 claims at $508 avg paid/claim, and 81301 produced $204.9K (9.1%) with 599 claims at $342 avg paid/claim; together these three drive nearly all Medicare revenue.
Medicare: Total Revenue Breakdown by CPT/HCPCS Code
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
Medicare: Complete Services Breakdown
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81455 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as tumor tissue or bone marrow, for DNA and possibly RNA alterations in 51 or more genes known to… | 600 | $2,860 | $1.7M |
| 81194 | The lab analyst performs the technical lab test using a specimen such as formalin–fixed paraffin embedded tissue (FFPE) to analyze NTRK (neurotrophic receptor tyrosine kinase) translocations for the… | 600 | $510 | $304.3K |
| 81301 | The lab analyst performs the technical lab test to detect the presence of microsatellite instability, also known as MSI, in tumor cells from tissue specimens such as colon cancer. | 600 | $340 | $204.9K |
| 81435 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least five genes, which relate to hereditary colon cancer–related disorders.… | 30 | $570 | $17.8K |
| 81436 | – WARNING – Code Deleted 2024‑12‑31 | 30 | $570 | $16.6K |
Medicare: Competitive Analysis & Benchmarks
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes. Note: this provider's state, "XX," is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Frequently Asked Questions
References
- 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
- 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.
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