Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Florida for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Florida only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Florida (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Ideal Diagnostic (NPI 1831816065)

Key Findings

Field	Value
Entity Type	Organization
Organization	Ideal Diagnostic
Address	2065 Ne 163rd St
City	North Miami Beach
State	FL
ZIP	33162
Taxonomy	Clinical Medical Laboratory
NPI Enumerated	October 27, 2022

Payer Source	Total Paid
Medicare	$4.9M
Medicaid	$0

IDEAL DIAGNOSTIC is operating as a specialized clinical genetic testing laboratory under the Clinical Medical Laboratory taxonomy, with its top revenue-driving codes all reflecting full-gene sequencing or targeted variant analysis for hereditary cancer and related genetic conditions (examples in the top codes include 81162, 81351, 81292, 81307, 81317 and 81201). The code mix—dominated by BRCA1/2, TP53, MLH1/MSH2/MSH6, PALB2, PMS2 and APC testing—indicates a service line focused on hereditary cancer panels and single-gene diagnostics rather than routine chemistry or anatomic pathology panels.

Revenue concentration is meaningful but not singular: the precomputed top-3 share shows that the top 3 Medicare codes by revenue account for 30.4% of this provider's total Medicare revenue. Individually those top codes are substantial contributors (for example, 81292 at $502.5K, 81351 at $491.2K, and 81162 at $481K), which signals reliance on a handful of high-value genetic tests while still leaving nearly 70% of Medicare revenue distributed across many other molecular codes.

Payer mix is effectively single-payer at present: Total Medicare revenue is $4.9M while Medicaid shows none on file, so the provider currently has no recorded Medicaid billing. This concentration of reimbursements in Medicare creates exposure to Medicare policy and fee-schedule shifts and suggests payer engagement or network strategies should be framed primarily around Medicare dynamics.

Competitive standing is national-strength on select assays: 81292 ranks #2 of 20 nationally (95th percentile; notably above typical national volume) and 81295 ranks #3 of 34 (94th percentile; notably above typical national volume), indicating the provider is a high-volume national performer for multiple mismatch-repair/colon-cancer–related tests. Several other high-revenue codes (for example 81351 at #5 of 24, 81162 at #9 of 35 and 81201 at #5 of 28) fall in the mid-to-high percentiles, which together suggest a competitive specialty footprint rather than a broad low-intensity lab.

The provider shows a mix of high-volume claim counts and high per-claim paid rates that drive revenue: for example, 81351 has 781 claims at $629 avg paid/claim and 81162 has 269 claims at $1788 avg paid/claim, while 81292 has 759 claims at $662 avg paid/claim. This combination of volume and elevated avg paid/claim—particularly for sequencing tests like 81162—helps explain how relatively few codes can produce large revenue contributions and signals to payers where utilization management or prior-authorization focus may yield savings.

Although several codes are high-percentile national performers, many of the remaining top-25 Medicare codes are described as “typical, unremarkable volume,” indicating the provider’s expertise is concentrated in a subset of hereditary cancer assays rather than across the entire genetic-testing universe. Examples of more typical-volume codes include 81307 (72th percentile), 81317 (82th percentile), and 81298 (82th percentile), which points to a focused but not universally dominant market position.

Statistical outliers are present but limited to specific assays: the dataset flags 81292 and 81295 as “notably above typical national volume,” which aligns with their top ranks and sizable revenue shares ($502.5K and $265.5K respectively). Most other high-revenue codes are listed with percentile placements characterized as typical or unremarkable, so payer or competitor attention should center on the handful of outlier assays where this provider has clear national-scale activity.

The provider is relatively new in Medicare billing: the NPI was enumerated on 2022-10-27 (~4 years ago), so this growth in Medicare molecular revenue to $4.9M has occurred within a short operating window. That abbreviated tenure combined with national-level volume for select hereditary cancer tests suggests rapid scaling of a focused genetic-testing business line rather than a long-established, diversified lab network.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

34 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
81292	The lab analyst performs the technical lab test to analyze the entire gene sequence for the mutL homolog 1, or MLH1 gene, also known as the colon cancer or nonpolyposis type 2 gene.	760	$660	$502.5K
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…	780	$630	$491.2K
81162	The lab analyst performs the technical lab test to analyze the entire gene sequence for the BRCA1, DNA repair–associated gene, also called BRCA1; and BRCA2, DNA repair–associated gene, also called…	270	$1,790	$481K
81307	The lab analyst performs the technical lab test on a specimen such as blood, to analyze the entire gene sequence for the partner and localizer of BRCA2 (PALB2) gene.	720	$660	$475.4K
81317	The lab analyst performs the technical lab test to analyze the entire gene sequence for the postmeiotic segregation increased 2 [S. cerevisiae], or PMS2 gene.	660	$660	$434.9K
81298	The lab analyst performs the technical lab test to analyze the entire gene sequence for the mutS homolog 6 [E. coli], or MSH6 gene.	660	$630	$417K
81201	The lab analyst performs the technical lab test to analyze the entire gene sequence for adenomatous polyposis coli, also known as APC.	520	$760	$399.6K
81295	The lab analyst performs the technical lab test to analyze the entire gene sequence for the mutS homolog 2, or MSH2 gene, also known as the colon cancer or nonpolyposis type 1 gene.	710	$370	$265.5K
81321	The lab analyst performs the technical lab test to analyze the entire gene sequence for the phosphatase and tensin homolog, or PTEN, gene.	450	$590	$264K
81300	The lab analyst performs the technical lab test to detect genetic changes involving long sequences of deleted or duplicated DNA in the gene for mutS homolog 6 [E. coli], or MSH6 gene.	740	$230	$172.4K

Showing 1–10 of 34

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
81307	10	30	320	$660	$508.3K
81321	10	30	430	$580	$467.7K
81238	18	20	330	$590	$440.3K
81162	4	20	100	$1,780	$403.3K
81249	21	20	290	$590	$383.1K
81223	21	20	340	$490	$329.3K
81351	5	20	210	$630	$307.8K
81334	18	20	390	$320	$295.7K
81323	2	10	470	$290	$229.2K
81311	19	20	270	$290	$213K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Total Renal Care Inc	FL	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$9.6M
Adriana Tafur Services Inc	FL	Rehabilitation Clinic/Center	$0	$8.8M
Jay Levy	FL	Ophthalmology Physician	$791.2K	$0
Sulaiman Alhumaid	FL	Retina Specialist (Ophthalmology) Physician	$282.6K	$0
Yaakov Siegel	FL	Forensic Psychologist	$146.2K	$0
Joseph Seber	FL	Dermatology Physician	$95.7K	$0
Stephen Wigley	FL	Foot & Ankle Surgery Podiatrist	$58.5K	$23K

Ideal Diagnostic — Billing Profile & Reimbursement Data

Sign up for Ideal Diagnostic — Billing Profile & Reimbursement Data policy alerts

Ideal Diagnostic — Billing Profile & Reimbursement Data

Sign up for Ideal Diagnostic — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References