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NPI 1861568784 · Aliso Viejo, CA · Clinical Medical Laboratory
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Ambry Genetics Corporation is a clinical medical laboratory provider located in Aliso Viejo, California. This profile covers 3 Medicare and 48 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 | Ambry Genetics Corporation |
| Address | 7 Argonaut |
| City | Aliso Viejo |
| State | CA |
| ZIP | 92656 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | November 24, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $47.4M |
| Medicare | $40.8M |
Ambry Genetics’ billed services are concentrated in high-complexity molecular and genetic testing rather than routine lab work, as evidenced by Medicare top codes 81479 (molecular pathology), 0129U (BRCAplus™), and 0101U (ColoNext®) and Medicaid volume in codes such as 81162 (BRCA technical analysis), 81416/81415 (exome sequencing), and multiple gene-specific codes (e.g., 81292, 81317). The code mix points to a business model built around hereditary cancer panels, exome analysis, and proprietary laboratory analyses rather than broad clinical testing.
Medicare revenue is highly concentrated in a single code set: the precomputed top-3 Medicare codes account for 100.0% of this provider’s total Medicare revenue, with 81479 alone generating $39.9M revenue (97.8% of this provider's total Medicare revenue). That concentration indicates Medicare billing is essentially driven by non-specific molecular pathology procedures reported to 81479, making Medicare exposure tied closely to that one service.
Medicaid revenue shows meaningful but less extreme concentration: the precomputed top-3 Medicaid codes account for 67.1% of this provider’s total Medicaid revenue, led by 81162 with $20.9M revenue (44.9% of this provider's total Medicaid revenue) and 81479 contributing $8.4M revenue (17.9% of this provider's total Medicaid revenue). These figures indicate a two-code dominance in Medicaid with additional diversified gene-panel and exome services contributing the remainder.
Payer mix is balanced but Medicaid is slightly larger in scale: lifetime Medicaid revenue is $47.4M versus total Medicare revenue of $40.8M, so both payers are material to the provider’s business but Medicaid represents the larger single source by the amounts reported. This suggests Ambry’s commercial footprint in state programs and managed care tied to Medicaid may be at least as important as its Medicare business.
On competitive standing, Ambry is a major national participant for its top Medicare service: 81479 ranks #4 of 80 providers nationally (96th percentile) and is described as notably above typical national volume, indicating a dominant national position on this molecular pathology code. The proprietary PLA codes 0129U and 0101U both rank #1 of 1 providers nationally with no national peer volume comparison available, signaling Ambry provides exclusive or manufacturer-specific tests in Medicare data.
In-state Medicaid rankings show strong positioning on BRCA and related genetic testing: 81162 ranks #2 of 12 providers in-state (91th percentile) while 81479 ranks #9 of 45 providers in-state (82th percentile), both consistent with substantial share of Medicaid genetic testing volume in California. Multiple gene-specific and panel codes (for example, 81416 and 81415) also rank #1 of 2 providers in-state (100th percentile), which suggests Ambry operates exclusive or limited-competition offerings for certain high-complexity assays within the state.
Ambry reports very large claim volumes on several Medicaid codes, including 81162 with 32.7K claims, 81479 with 10K claims, and U0003 with 28.1K claims, indicating significant operational throughput in both hereditary cancer testing and high-throughput infectious disease testing during the period covered. High claim counts combined with substantial per-claim payments (for example, $641 avg paid/claim for 81162 and $834 avg paid/claim for Medicaid 81479) underline a business that combines volume and high-unit reimbursements for complex genetic services.
The provider has long operational tenure in Medicare/Medicaid networks: NPI enumeration on 2006-11-24 (~20 years ago) points to an established laboratory with prolonged participation in federal and state payer programs, supporting the scale and specialized service lines seen in the claims mix. This tenure, together with the presence of proprietary PLA codes and top-percentile ranks, reinforces Ambry’s profile as a mature specialty genetic testing lab rather than a new market entrant.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 22,540 | $1,770 | $39.9M |
| 0129U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0129U for the… | 470 | $1,270 | $593.7K |
| 0101U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0101U for the… | 170 | $1,710 | $297.4K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 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.
48 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 32,680 | $640 | $20.9M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 10,020 | $830 | $8.4M |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 28,060 | $70 | $2M |
| 81416 | The lab analyst performs an exome gene sequence analysis in a relative of the patient to create a reference exome gene sequence, which the lab analyst can compare to the patient’s exome to evaluate… | 590 | $3,320 | $2M |
| 81415 | The lab analyst performs an exome gene sequence analysis to look for genetic changes that could account for an unexplained disorder or syndrome in the patient. | 1,330 | $1,290 | $1.7M |
| 81211 | N/A | 2,280 | $700 | $1.6M |
| 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. | 7,000 | $200 | $1.4M |
| 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. | 6,910 | $180 | $1.2M |
| 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. | 6,980 | $160 | $1.1M |
| 81408 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 9 molecular pathology code. | 2,010 | $380 | $756.1K |
Showing 1–10 of 48
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
48 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81420 | The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,… | 13 | 30 | 300 | $260 | $18M |
| 81408 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 9 molecular pathology code. | 4 | 10 | 380 | $230 | $10.8M |
| 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… | 2 | 10 | 440 | $500 | $5.3M |
| 81419 | The lab analyst performs the technical lab test on a specimen such as blood to conduct a genomic sequence analysis panel. The test evaluates the genetic sequences of at least the 24 genes listed in… | 3 | 10 | 180 | $390 | $1.1M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 9 | 50 | 500 | $160 | $1.1M |
| 81416 | The lab analyst performs an exome gene sequence analysis in a relative of the patient to create a reference exome gene sequence, which the lab analyst can compare to the patient’s exome to evaluate… | 1 | 10 | 390 | $2,540 | $989.5K |
| 81211 | N/A | 2 | 10 | 2,280 | $470 | $930.3K |
| 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. | 2 | 10 | 3,630 | $140 | $928.8K |
| 81415 | The lab analyst performs an exome gene sequence analysis to look for genetic changes that could account for an unexplained disorder or syndrome in the patient. | 1 | 10 | 820 | $1,100 | $894.9K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 58 | 750 | 950 | $50 | $890K |
Showing 1–10 of 48
Other providers in the same ZIP code as Ambry Genetics Corporation, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Neogenomics Laboratories Inc | CA | Clinical Medical Laboratory | $32.6M | $21.5M |
| Bridge Diagnostics LLC | CA | Clinical Medical Laboratory | $352.5K | $8.5M |
| Kenneth Martinez | CA | Neurology Physician | $1.6M | $7.8K |
| George Shahinian | CA | Pulmonary Disease Physician | $976.4K | $2.2K |
| Ambika Bhushan | CA | Internal Medicine Physician | $207.8K | $0 |
| Parastou Abedi | CA | Ophthalmology Physician | $190.4K | $15K |
| Vangie Tran | CA | Family Nurse Practitioner | $200K | $0 |
| Maria Criselda Leoncio | CA | Physical Therapist | $194.2K | $0 |
| Mindy Bixby | CA | Neurology Physician | $107.9K | $33.2K |
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