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NPI 1780308262 · Pensacola, FL · Clinical Medical Laboratory
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Circulogene Theranostics, Inc. is a clinical medical laboratory provider located in Pensacola, Florida. This profile covers 9 Medicare and 8 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 | Circulogene Theranostics, Inc. |
| Address | 219 E Garden St Ste 300 |
| City | Pensacola |
| State | FL |
| ZIP | 32502 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | September 28, 2022 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $6.3M |
| Medicaid | $550.6K |
CIRCULOGENE THERANOSTICS, INC. operates as a specialized clinical medical laboratory focused on advanced genomic and tumor profiling services rather than routine clinical testing; its Medicare top codes are dominated by high-complexity oncology/genomic panels such as 81455, 81194, and 81301, which are specific to broad genomic sequencing, NTRK translocation testing, and microsatellite instability testing respectively. This code mix indicates an operational emphasis on precision oncology diagnostics and panel-based molecular assays billed to both Medicare and Medicaid.
Medicare revenue is highly concentrated: the precomputed top-3 Medicare codes (81455, 81194, 81301) account for 89.8% of this provider's total Medicare revenue, with 81455 alone generating $4.4M (70.0% of Medicare revenue). That concentration signals dependence on a few high-revenue molecular tests for the $6.3M in Medicare receipts.
Medicaid revenue is likewise concentrated: the precomputed top-3 Medicaid codes account for 80.6% of the provider's total Medicaid revenue, led by 81455 at $341.7K (62.1% of Medicaid revenue) and supplemented by 81432 ($53.1K, 9.6%) and 81435 ($49.1K, 8.9%). These figures show that a single high-complexity panel (81455) dominates Medicaid billing as well, even though total Medicaid revenue ($550.6K) is much smaller than Medicare.
Payer mix is skewed strongly toward Medicare: reported lifetime Medicare revenue is $6.3M versus Medicaid revenue of $550.6K, so Medicare is the dominant payer by scale for this provider. The provider also experiences large payer-level payment differences on the same service—for example, 81455 pays $2861 avg/claim on Medicare versus $738 avg/claim on Medicaid—highlighting meaningful revenue-per-claim divergence across payers.
On competitive standing for key tests, CIRCULOGENE shows national prominence for select molecular assays: 81194 ranks #1 of 7 providers nationally at the 100th percentile (notably above typical national volume) and 81301 ranks #1 of 20 providers nationally at the 100th percentile (characterized as an extreme outlier), while 81455 ranks #4 of 36 nationally at the 91st percentile (a high but not unprecedented national volume). These rankings indicate the lab is a leading national performer for specific niche oncology tests despite being a relatively young enumerated NPI.
Within Florida Medicaid, the provider is a top in-state performer for key panels: 81455 ranks #1 of 5 in-state at the 100th percentile (notably above typical state volume). Several other Medicaid codes (81432, 81435) also show the provider as the sole or top in-state reporter, which suggests a locally important role for select hereditary and oncology panel services despite modest aggregate Medicaid revenue.
The NPI was enumerated on 2022-09-28 (~4 years ago), so this is a relatively recent market entrant that has already achieved substantial volumes on a handful of high-complexity tests. Rapid scaling to the reported volumes—especially the extreme-outlier national volumes for 81301 and top ranking for 81194—suggests focused growth in oncology/genomic diagnostics since enumeration.
Operational and coding monitoring implications: the dataset includes claims for 81436 with the label WARNING – Code Deleted 2024‑12‑31 on both payers, which likely reflects historical use or pre-deletion billing patterns and should be watched for coding transitions. Given the heavy revenue concentration in a few high-value codes and large payer rate disparities, contract negotiation, coding updates, and utilization management will materially affect this provider's revenue profile.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
9 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… | 1,550 | $2,860 | $4.4M |
| 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… | 1,400 | $510 | $711.2K |
| 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. | 1,570 | $340 | $536.3K |
| 81456 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as tumor tissue or bone marrow, for RNA alterations in 51 or more genes known to relate to solid… | 170 | $2,860 | $497.8K |
| 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.… | 90 | $570 | $52.1K |
| 81436 | – WARNING – Code Deleted 2024‑12‑31 | 90 | $570 | $50.4K |
| 81432 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least five genes relating to disorders associated with hereditary breast cancer… | 40 | $670 | $26.6K |
| 81351 | The lab analyst performs the technical lab test on a specimen such as blood to analyze the entire gene sequence for the tumor protein 53 (TP53) gene, which may indicate a diagnosis of Li–Fraumeni… | 20 | $630 | $10.7K |
| 81163 | The lab analyst performs the technical lab test to analyze the entire gene sequence for the BRCA1 DNA repair–associated gene, also known as BRCA1, and the BRCA2 DNA repair–associated gene, also known… | 10 | $460 | $6.4K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 9 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
8 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… | 460 | $740 | $341.7K |
| 81432 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least five genes relating to disorders associated with hereditary breast cancer… | 130 | $400 | $53.1K |
| 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.… | 120 | $420 | $49.1K |
| 81436 | – WARNING – Code Deleted 2024‑12‑31 | 120 | $420 | $49.1K |
| 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. | 460 | $80 | $34.5K |
| 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… | 130 | $150 | $19.5K |
| 81456 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as tumor tissue or bone marrow, for RNA alterations in 51 or more genes known to relate to solid… | 270 | $10 | $3.3K |
| 81433 | (Deleted effective January 1, 2025) | 110 | $1 | $320 |
How this provider's Medicaid billing volume and revenue compare to other Florida providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Florida median
8 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81436 | – WARNING – Code Deleted 2024‑12‑31 | 2 | 10 | 340 | $280 | $94K |
| 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… | 1 | 10 | 40 | $600 | $74.3K |
| 81432 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least five genes relating to disorders associated with hereditary breast cancer… | 1 | 10 | 130 | $400 | $53K |
| 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.… | 1 | 10 | 120 | $420 | $49.1K |
| 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. | 1 | 10 | 460 | $80 | $34.6K |
| 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… | 1 | 10 | 60 | $100 | $6.6K |
| 81456 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as tumor tissue or bone marrow, for RNA alterations in 51 or more genes known to relate to solid… | 1 | 10 | 270 | $10 | $3.2K |
| 81433 | (Deleted effective January 1, 2025) | 1 | 10 | 110 | $1 | $350 |
Other providers in the same ZIP code as Circulogene Theranostics, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Sabrina Evans | FL | Family Nurse Practitioner | $340.6K | $0 |
| Kevin Groom | FL | Clinical Neuropsychologist | $157.2K | $0 |
| Mark Giovanini | FL | Neurological Surgery Physician | $63.8K | $0 |
| Sean Kirby | FL | Physician Assistant | $47.4K | $0 |
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