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NPI 1891718136 · Sioux Falls, SD · Clinical Medical Laboratory
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Avera Mckennan is a clinical medical laboratory provider located in Sioux Falls, South Dakota. This profile covers 170 Medicare and 101 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 | Avera Mckennan |
| Address | 1301 S Cliff Ave |
| City | Sioux Falls |
| State | SD |
| ZIP | 57105 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | July 26, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $2M |
| Medicare | $307.1K |
Payer mix and scale are concentrated in Medicaid: this provider reports $307.1K in total Medicare revenue versus $2M in total Medicaid revenue, indicating Medicaid is the dominant payer by a wide margin. Revenue concentration is nontrivial for both payers: the provider’s top three Medicare codes account for 31.3% of Medicare revenue, while the top three Medicaid codes account for 39.1% of Medicaid revenue.
Clinical service lines point to a mixed laboratory model that handles high-volume public health and infectious-disease testing alongside routine chemistry and endocrine assays. Medicaid top codes 87591 and 87491 (7.7K and 7.6K claims respectively) and U0003 (2.4K claims) show large-scale NAAT and high-throughput SARS‑CoV‑2 testing activity, while Medicare top codes such as 82306 and 83970 and the higher‑paid molecular code 0241U suggest a complement of endocrine/nutrition (vitamin D, PTH) and specialty molecular testing.
Medicare competitive positioning is relatively strong on selected assays despite modest overall Medicare revenue: 82306 ($30.7K revenue) ranks #342 of 12453 providers nationally at the 97th percentile and 0241U ($16.2K revenue) ranks #114 of 2910 at the 96th percentile, described in the source as typical, unremarkable volumes at high national percentiles. These ranks imply the lab is a nationally visible performer for a few specific diagnostics but its total Medicare footprint ($307.1K) remains limited compared with larger national reference labs.
On Medicaid the provider is a leading in‑state performer for STI and respiratory testing: 87591 ($237.3K, 7.7K claims) ranks #2 of 15 in-state (93rd percentile) and 87491 ($234.8K, 7.6K claims) ranks #3 of 16 in-state (87th percentile), while U0003 ($174.7K, 2.4K claims) ranks #3 of 26 in-state (92nd percentile). The dataset labels these volumes as typical for the state at high percentiles, which together with the absolute Medicaid revenues indicates the lab is a significant state supplier of GC/Chlamydia NAAT and high-throughput COVID testing.
There are several Medicaid codes where the provider is effectively a state outlier for women’s health and point‑of‑care STI panels: 87660, 87510, and 87480 each report rank #1 of 7 providers in-state and are identified as 100th percentile and "notably above typical state volume for this code." That pattern suggests the lab holds local market leadership for Trichomonas, Gardnerella, and Candida NAAT testing used in urogenital infectious disease screening.
Operational throughput signals are visible in bill counts and low average paid amounts for phlebotomy and culture work: Medicare shows 36415 with 1.7K claims ($13.2K revenue) and Medicaid shows 36415 with 5K claims ($20.1K revenue), while urine culture 87086 appears on both payers (Medicare 1.1K claims, Medicaid 6.2K claims). These high claim counts paired with low avg paid/claim indicate substantial specimen collection and routine microbiology throughput supporting the lab’s higher‑revenue molecular and specialty assays.
Revenue concentration within each payer highlights dependency on a few tests: the top three Medicare codes represent 31.3% of Medicare revenue and the top three Medicaid codes represent 39.1% of Medicaid revenue, meaning fluctuations in volumes or reimbursement for those specific assays (e.g., 82306, 83970, 0241U on Medicare; 87591, 87491, U0003 on Medicaid) would materially affect payer revenue. For contracting and utilization management, that concentration suggests negotiating leverage or risk should focus on those named codes.
The provider has long tenure in the NPI registry (enumerated 2006-07-26, ~20 years ago), which supports interpretation of these patterns as the result of an established laboratory operation rather than a newly created testing entity. Combined with the payer‑specific rank data and the mixed portfolio of high‑volume NAATs, routine chemistries, and specialty molecular assays, the profile is consistent with an established clinical laboratory that is a significant Medicaid vendor in‑state and a selective national performer on a handful of Medicare assays.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
170 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 1,060 | $30 | $30.7K |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 450 | $40 | $18K |
| 0241U | N/A | 120 | $140 | $16.2K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 910 | $20 | $14.5K |
| 0240U | N/A | 100 | $140 | $13.6K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 1,660 | $10 | $13.2K |
| 87086 | Culture, bacterial; quantitative, colony count, urine. | 1,140 | $10 | $9.1K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 870 | $10 | $8.7K |
| 87077 | The lab analyst performs additional tests on a presumptively identified aerobic isolate to definitively, which means more specifically, identify the organism, such as to the level of species. | 840 | $10 | $6.7K |
| 83521 | The lab analyst performs a chemistry test to measure the level of each immunoglobulin light chain, kappa or lambda, in a serum specimen. A common lab method for this test is turbidimetry, which uses… | 390 | $20 | $6.7K |
Showing 1–10 of 170
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 170 CPT/HCPCS codes.
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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.
101 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 7,660 | $30 | $237.3K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 7,570 | $30 | $234.8K |
| 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… | 2,360 | $70 | $174.7K |
| 0241U | N/A | 1,290 | $120 | $151.9K |
| 87651 | The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat. | 3,140 | $30 | $97.2K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 2,970 | $20 | $71.4K |
| 0240U | N/A | 670 | $100 | $68.6K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 3,130 | $20 | $59.5K |
| 86780 | The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to Treponema pallidum, a spiral shaped bacteria called a spirochete, that causes syphilis. | 4,660 | $10 | $51.2K |
| 87660 | The lab analyst performs a test for Trichomonas vaginalis using direct nucleic acid probe technique. | 2,640 | $20 | $50.1K |
Showing 1–10 of 101
How this provider's Medicaid billing volume and revenue compare to other South Dakota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Dakota median
101 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 0202U | 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 0202U for the… | 5 | 10 | 170 | $360 | $236.6K |
| 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… | 3 | 30 | 270 | $70 | $138.6K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 15 | 20 | 210 | $50 | $104.8K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 22 | 110 | 990 | $20 | $82.9K |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 3 | 10 | 420 | $50 | $80.4K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 2 | 20 | 520 | $30 | $79.8K |
| 87522 | A lab tests a patient’s specimen to measure the amount of hepatitis C virus present. This may be referred to as viral load. | 2 | 10 | 1,680 | $50 | $77.4K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 3 | 20 | 490 | $30 | $76.2K |
| 0240U | N/A | 4 | 10 | 270 | $100 | $68.6K |
| 0241U | N/A | 3 | 40 | 150 | $120 | $65.1K |
Showing 1–10 of 101
Other providers in the same ZIP code as Avera Mckennan, ranked by combined Medicare and Medicaid revenue.
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