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NPI 1790869402 · Malvern, PA · Physiological Laboratory
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Cardionet, LLC is a physiological laboratory provider located in Malvern, Pennsylvania. This profile covers 10 Medicare and 16 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 | Cardionet, LLC |
| Address | 2476 Swedesford Rd Ste 350 |
| City | Malvern |
| State | PA |
| ZIP | 19355 |
| Taxonomy | Physiological Laboratory |
| NPI Enumerated | October 25, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $63.2M |
| Medicare | $11M |
CARDIONET, LLC’s billing mix is concentrated in ambulatory cardiac monitoring and central processing services: its top Medicare and Medicaid codes correspond to prolonged ambulatory ECG monitoring and technician/processing-center analysis (examples include 93243, 93247, and 93229). High claim counts for these codes (Medicare: 93243 34.5K claims; Medicaid: 93229 91.3K claims) and the code descriptions indicate a business that places wearable ECG devices, collects long‑duration recordings, and provides centralized scanning and reporting rather than office‑based evaluation.
Medicare revenue is highly concentrated in three procedure lines: the precomputed top-three Medicare codes account for 98.1% of this provider’s total Medicare revenue, driven primarily by 93243 (62.9% of Medicare revenue), 93247 (30.8%), and 93226 (4.4%). With total Medicare revenue of $11M and the three codes above representing virtually all of it, the Medicare-facing activity appears narrowly focused on prolonged ECG recording and analysis.
Medicaid revenue is also concentrated: the precomputed top-three Medicaid codes account for 89.1% of this provider’s total Medicaid revenue, dominated by 93229 (62.5% of Medicaid revenue), 93243 (16.7%), and 93271 (9.9%). Given total Medicaid revenue of $63.2M, the provider’s Medicaid business is overwhelmingly driven by wearable ECG placement and large-scale transmission/processing services.
Payer mix is heavily skewed toward Medicaid: lifetime Medicaid revenue is $63.2M versus Medicare revenue of $11M, indicating a much larger Medicaid footprint and suggesting the firm’s commercial and state-contracted relationships are more material to its volume and revenue base than Medicare. This profile makes the entity effectively a Medicaid-dominant operator in scale.
Competitive standing on Medicare shows unusually high national volume for core processing codes: 93243 ranks #2 of 51 nationally (98th percentile), 93226 ranks #3 of 133 (98th percentile), and 93247 ranks #4 of 42 (93rd percentile). These percentiles and ranks signal that CARDIONET is a top national processor for specific prolonged ECG analysis codes rather than a marginal participant.
On Medicaid, CARDIONET is the clear statewide leader for multiple high-revenue codes: 93229, 93243, and 93271 each rank #1 in-state (100th percentile for those codes), and several other monitoring codes also rank at or near the top of state peers. Those #1 rankings combined with the code-level revenue (e.g., 93229 $39.5M) indicate a dominant market position in Pennsylvania for ambulatory cardiac monitoring services.
Payment and unit‑rate patterns differ across payers for the same services: for example, 93229 shows an average paid/claim of $714 in Medicare (179 claims, $127.8K revenue) versus $432 in Medicaid (91.3K claims, $39.5M revenue), and 93243 averages $200 paid/claim in Medicare (34.5K claims, $6.9M) versus $164 in Medicaid (64.3K claims, $10.5M). These contrasts reflect both very different volumes by payer and materially different unit payments for identical CPT/HCPCS codes across Medicare and Medicaid.
The NPI enumeration date is 2006-10-25 (~20 years ago), indicating long tenure in the market; combined with multiple labels of unusually high volume and several codes flagged as “extreme outlier” or at the 100th percentile, the pattern suggests an established, high-throughput monitoring and processing operation rather than recent or isolated activity.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 93243 | After a patient has worn an electrocardiographic, or ECG recorder, for more than 48 hours, up to 7 days, to detect abnormal heart rates and rhythm, a processing center technician performs a scanning… | 34,520 | $200 | $6.9M |
| 93247 | After a patient has worn an electrocardiographic, or ECG recorder, for more than seven days, up to 15 days, to detect abnormal heart rates and rhythm, a processing center technician performs a… | 16,030 | $210 | $3.4M |
| 93226 | The physician or other healthcare professional applies an electrocardiographic, or ECG recorder, to a patient for up to 48 hours to help detect abnormal heart rates and rhythms. This service reports… | 15,920 | $30 | $477.7K |
| 93229 | In this procedure, the provider, typically a technician, places a wearable electrocardiographic monitoring device on the patient, instructs him in its use, and monitors the transmissions, to detect… | 180 | $710 | $127.8K |
| 93242 | In this procedure, the provider applies an electrocardiographic, or ECG recorder, to a patient who wears it for more than 48 hours, up to seven days, to help detect abnormal heart rates and… | 4,510 | $10 | $36.1K |
| 93246 | In this procedure, the provider applies an electrocardiographic, or ECG recorder, to a patient who wears it for more than seven days, up to 15 days, to help detects abnormal heart rates and… | 2,930 | $10 | $23.4K |
| 93271 | In this service, the provider monitors the patient’s heart rhythm while the patient is experiencing cardiac symptoms. He places electrocardiogram leads of an event recorder on the patient's chest,… | 100 | $130 | $12.1K |
| 93225 | The physician or other healthcare professional applies an electrocardiographic, or ECG recorder, to a patient for up to 48 hours to help detect abnormal heart rates and rhythms. This service reports… | 730 | $10 | $8.8K |
| 93296 | The technician gathers data, for a period of up to 90 days, from a patient’s single, dual, multiple lead, or leadless pacemaker system or implantable defibrillator system by remotely accessing the… | 40 | $20 | $800 |
| 93270 | In this service, the provider monitors the patient’s heart rhythm while the patient is experiencing cardiac symptoms. He places electrocardiogram leads of an event recorder on the patient's chest,… | 30 | $10 | $160 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 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.
16 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 93229 | In this procedure, the provider, typically a technician, places a wearable electrocardiographic monitoring device on the patient, instructs him in its use, and monitors the transmissions, to detect… | 91,340 | $430 | $39.5M |
| 93243 | After a patient has worn an electrocardiographic, or ECG recorder, for more than 48 hours, up to 7 days, to detect abnormal heart rates and rhythm, a processing center technician performs a scanning… | 64,270 | $160 | $10.5M |
| 93271 | In this service, the provider monitors the patient’s heart rhythm while the patient is experiencing cardiac symptoms. He places electrocardiogram leads of an event recorder on the patient's chest,… | 90,230 | $70 | $6.2M |
| 93247 | After a patient has worn an electrocardiographic, or ECG recorder, for more than seven days, up to 15 days, to detect abnormal heart rates and rhythm, a processing center technician performs a… | 22,880 | $190 | $4.2M |
| 93226 | The physician or other healthcare professional applies an electrocardiographic, or ECG recorder, to a patient for up to 48 hours to help detect abnormal heart rates and rhythms. This service reports… | 79,260 | $20 | $1.5M |
| 0297T | N/A | 12,380 | $50 | $631.5K |
| G0249 | Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage… | 13,240 | $20 | $278.1K |
| 93270 | In this service, the provider monitors the patient’s heart rhythm while the patient is experiencing cardiac symptoms. He places electrocardiogram leads of an event recorder on the patient's chest,… | 17,140 | $10 | $171.4K |
| 93225 | The physician or other healthcare professional applies an electrocardiographic, or ECG recorder, to a patient for up to 48 hours to help detect abnormal heart rates and rhythms. This service reports… | 2,260 | $20 | $33.9K |
| 93242 | In this procedure, the provider applies an electrocardiographic, or ECG recorder, to a patient who wears it for more than 48 hours, up to seven days, to help detect abnormal heart rates and… | 4,720 | $10 | $23.6K |
Showing 1–10 of 16
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
16 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 93229 | In this procedure, the provider, typically a technician, places a wearable electrocardiographic monitoring device on the patient, instructs him in its use, and monitors the transmissions, to detect… | 1 | 10 | 3,520 | $430 | $13.6M |
| 93243 | After a patient has worn an electrocardiographic, or ECG recorder, for more than 48 hours, up to 7 days, to detect abnormal heart rates and rhythm, a processing center technician performs a scanning… | 1 | 10 | 32,170 | $160 | $5.3M |
| 93247 | After a patient has worn an electrocardiographic, or ECG recorder, for more than seven days, up to 15 days, to detect abnormal heart rates and rhythm, a processing center technician performs a… | 1 | 10 | 22,880 | $190 | $4.2M |
| 93271 | In this service, the provider monitors the patient’s heart rhythm while the patient is experiencing cardiac symptoms. He places electrocardiogram leads of an event recorder on the patient's chest,… | 1 | 10 | 330 | $70 | $1.1M |
| 0297T | N/A | 1 | 10 | 6,220 | $50 | $318.1K |
| G0249 | Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage… | 1 | 10 | 13,240 | $20 | $276.1K |
| 93226 | The physician or other healthcare professional applies an electrocardiographic, or ECG recorder, to a patient for up to 48 hours to help detect abnormal heart rates and rhythms. This service reports… | 1 | 40 | 70 | $20 | $51.1K |
| 93270 | In this service, the provider monitors the patient’s heart rhythm while the patient is experiencing cardiac symptoms. He places electrocardiogram leads of an event recorder on the patient's chest,… | 1 | 10 | 50 | $10 | $25K |
| 93225 | The physician or other healthcare professional applies an electrocardiographic, or ECG recorder, to a patient for up to 48 hours to help detect abnormal heart rates and rhythms. This service reports… | 2 | 50 | 90 | $60 | $17.2K |
| G2066 | Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system,… | 3 | 50 | 120 | $20 | $15.2K |
Showing 1–10 of 16
Other providers in the same ZIP code as Cardionet, LLC, ranked by combined Medicare and Medicaid revenue.
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