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NPI 1821253584 · Irvine, CA · Clinical Medical Laboratory
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Agendia Inc is a clinical medical laboratory provider located in Irvine, California. This profile covers 2 Medicare and 4 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 | Agendia Inc |
| Address | 22 Morgan |
| City | Irvine |
| State | CA |
| ZIP | 92618 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | July 22, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $10.2M |
| Medicaid | $5.1M |
AGENDIA INC operates as a specialized molecular diagnostic laboratory centered on multigene assay testing: the dominant procedure across both payers is 81521, a 70-gene mRNA microarray test that reports a breast cancer recurrence score. Medicare records show 2.7K claims for 81521 with a $3787 avg paid/claim generating $10.1M in Medicare revenue, and Medicaid records show 4.8K claims with a $948 avg paid/claim generating $4.6M in Medicaid revenue, indicating the lab’s core service line is high-complexity genomic testing for oncology.
Revenue concentration is extreme on Medicare: 81521 alone accounts for 98.9% of this provider’s total Medicare revenue, and the precomputed top-3 codes collectively account for 100.0% of Medicare revenue. This indicates Medicare receipts are effectively driven by a single, high-revenue test rather than a broad portfolio of procedures.
Medicaid revenue is also highly concentrated but slightly more diversified: 81521 represents 88.7% of Medicaid revenue while 81599 contributes 10.1%, and the top three Medicaid codes account for 99.8% of Medicaid revenue. This pattern shows Medicaid business is similarly dependent on the principal multianalyte assay line, with 81599 (MAAA uncoded test) as a secondary contributor.
Payer mix shows both payers are meaningful for this provider: total Medicare revenue is $10.2M and total Medicaid revenue is $5.1M, so the provider receives substantial business from each payer rather than being strictly single-payer. The larger absolute Medicare dollar total suggests Medicare is the dominant revenue source by scale, but Medicaid still represents a significant portion of overall volume and revenue.
Competitive standing is idiosyncratic by payer and code: for 81521 the provider ranks #1 of 1 nationally on Medicare (0th percentile; no national peer volume comparison available) and #1 of 1 in-state on Medicaid (0th percentile; no state peer volume comparison available), which indicates there are no comparable peers in the dataset for that specific code in those geographies. In contrast, for supporting procedures the provider shows more typical comparative positions—88381 ranks #9 of 224 nationally for Medicare (96th percentile; typical, unremarkable volume for this code) and 81599 ranks #3 of 10 in-state for Medicaid (78th percentile; typical, unremarkable volume for this code)—suggesting strong proprietary volume for the core assay but otherwise ordinary volumes for ancillary pathology services.
Reimbursement profile differs sharply by payer for the same core test: the avg paid/claim for 81521 is $3787 on Medicare versus $948 on Medicaid as reported, which points to substantial per-claim payment variation between payers for the identical billed procedure. Analysts should expect payer-specific pricing and reimbursement arrangements to materially affect unit economics for the lab’s dominant test.
Operational tenure is long-standing: the provider NPI was enumerated on 2008-07-22 (~18 years ago), indicating an established presence in payer networks and a long operating history to build specialized test volumes. This tenure supports the accumulated claims volumes reported (multiple thousands of claims for 81521 across both payers).
Statistical descriptors in the source data should be interpreted as provided: 81521 listings carry the note that no peer volume comparison is available (rank #1 of 1, 0th percentile) for both Medicare and Medicaid, so its market standing in the dataset reflects uniqueness rather than a measured high-volume percentile; by contrast, ancillary codes such as 88381 (Medicare rank #9 of 224, 96th percentile; typical, unremarkable volume) and 81599 (Medicaid rank #3 of 10, 78th percentile; typical, unremarkable volume) are described in the source as having typical or unremarkable volumes relative to their peer groups. These plain-English labels should guide interpretation of whether an observed rank denotes uniqueness in the dataset versus a statistically notable outlier.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81521 | The lab analyst performs the technical lab tests to analyze 70 genes using mRNA microarray analysis, and carries out an algorithmic analysis using patient data and the lab test results to report a… | 2,670 | $3,790 | $10.1M |
| 88381 | A clinician, typically a pathologist, performs a manual microdissection of a patient’s specimen, such as a biopsy or tissue preserved from a previous case. | 640 | $180 | $117K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 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.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81521 | The lab analyst performs the technical lab tests to analyze 70 genes using mRNA microarray analysis, and carries out an algorithmic analysis using patient data and the lab test results to report a… | 4,810 | $950 | $4.6M |
| 81599 | Use 81599 to report a multianalyte assay with algorithmic analysis, or MAAA test, that does not have a specific Category I code or an administrative code in Appendix O. | 3,440 | $150 | $519.6K |
| 88381 | A clinician, typically a pathologist, performs a manual microdissection of a patient’s specimen, such as a biopsy or tissue preserved from a previous case. | 1,050 | $50 | $52.7K |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 50 | $160 | $7.9K |
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
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81521 | The lab analyst performs the technical lab tests to analyze 70 genes using mRNA microarray analysis, and carries out an algorithmic analysis using patient data and the lab test results to report a… | 1 | 10 | 4,810 | $950 | $4.6M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 36 | 50 | 500 | $160 | $1.1M |
| 81599 | Use 81599 to report a multianalyte assay with algorithmic analysis, or MAAA test, that does not have a specific Category I code or an administrative code in Appendix O. | 3 | 10 | 360 | $90 | $275.4K |
| 88381 | A clinician, typically a pathologist, performs a manual microdissection of a patient’s specimen, such as a biopsy or tissue preserved from a previous case. | 4 | 10 | 410 | $80 | $259.5K |
Other providers in the same ZIP code as Agendia Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Mdxhealth, Inc. | CA | Clinical Medical Laboratory | $24M | $797.5K |
| Biognomics Lab, LLC | CA | Clinical Laboratory Director (Non-physician) | $16.4M | $235.6K |
| Shoreline Diagnostics LLC | CA | Clinical Medical Laboratory | $6.2M | $9.6M |
| 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 |
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