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NPI 1891909941 · Pine Brook, NJ · Clinical Medical Laboratory
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Siparadigm LLC is a clinical medical laboratory provider located in Pine Brook, New Jersey. This profile covers 49 Medicare and 32 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 | Siparadigm LLC |
| Address | 25 Riverside Dr Ste 2 |
| City | Pine Brook |
| State | NJ |
| ZIP | 07058 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | May 9, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $13.5M |
| Medicare | $9.9M |
SIPARADIGM LLC is a Clinical Medical Laboratory with an NPI enumerated 2007-05-09 (~19 years ago). Its billing mix on Medicare and Medicaid is concentrated in molecular/genomic assays, in situ hybridization/immunostaining, and flow cytometry—services consistent with a lab performing high-complexity anatomic pathology and molecular testing rather than routine chemistry or primary care diagnostics.
Medicare revenue totals $9.9M and is highly concentrated: the top 3 Medicare codes account for 74.3% of this provider's total Medicare revenue. The leading Medicare code is 81455 ($4.3M, 44.5%), followed by 88377 ($1.9M, 20.1%) and 88185 ($931.1K, 9.6%), indicating that genomic panels, complex ISH assays, and extensive flow cytometry are the primary Medicare drivers.
On Medicare, the provider is a national outlier for several specialized pathology procedures: 88377 ranks #2 of 616 providers nationally (100th percentile; extreme outlier) and 88185 ranks #8 of 618 (99th percentile; extreme outlier). At the same time, 81455 (rank #5 of 36; 89th percentile; typical, unremarkable volume) shows the lab has substantial but not uniquely dominant national volume in large genomic panels, suggesting pockets of national leadership alongside other high-volume specialty behavior.
Medicaid revenue is larger than Medicare at $13.5M, so the provider is effectively more Medicaid-weighted in scale. This Medicaid load is extremely concentrated in COVID-related testing and specimen collection: the top 3 Medicaid codes account for 89.8% of Medicaid revenue, led by U0003 ($9.1M, 66.8%), U0005 ($2.3M, 16.6%), and G2023 ($875.4K, 6.4%).
The Medicaid code mix (U0003: 153.6K claims, U0005: 125K claims, G2023: 109.4K claims) indicates a high-throughput infectious-disease testing and specimen-collection operation serving New Jersey Medicaid. Those codes rank in-state as U0003 #12 of 127 (91th percentile; typical), U0005 #13 of 142 (91th percentile; typical), and G2023 #6 of 179 (97th percentile; notably above typical state volume), supporting that SIPARADIGM is a major state participant in COVID testing and specimen collection workflows.
Beyond COVID testing, the provider shows repeated national extreme-outlier signals across pathology/hematopathology codes (examples include 88368 rank #1 of 195, 85097 rank #4 of 2060, G0452 rank #6 of 614, and 88184 rank #9 of 616—all flagged as extreme outlier or very high percentile). These flags, together with large claim volumes (for example 42.3K claims for 88185 on Medicare), imply the lab operates substantial high-throughput pathology and flow cytometry capacity.
The revenue profile carries concentration risk: Medicare reliance on three codes (74.3% of Medicare revenue) and Medicaid reliance on three codes (89.8% of Medicaid revenue), combined with overall payer skew toward Medicaid ($13.5M vs $9.9M), means shifts in reimbursement, coding rules, or COVID demand could meaningfully affect the provider’s topline. The provider’s long tenure (NPI since 2007-05-09) suggests established operations, but monitoring of code-level volumes (especially U0003/U0005 and 88377/88185) is essential for forecasting revenue stability.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
49 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81455 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as tumor tissue or bone marrow, for DNA and possibly RNA alterations in 51 or more genes known to… | 1,510 | $2,850 | $4.3M |
| 88377 | The lab analyst applies a single multiplex in situ hybridization probe stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a… | 7,130 | $270 | $1.9M |
| 88185 | The lab analyst performs the technical component of a flow cytometry procedure using cell surface, cytoplasmic, or nuclear markers to characterize cells and aid clinicians in diagnosing patients with… | 42,320 | $20 | $931.1K |
| 88341 | The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified… | 5,140 | $60 | $323.6K |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 3,840 | $60 | $226.5K |
| 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… | 2,410 | $70 | $178K |
| 81450 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as blood or bone marrow, for DNA and possibly RNA alterations in five to 50 genes known to impact… | 230 | $740 | $168.9K |
| 88189 | The clinician, typically a pathologist, interprets flow cytometry results of 16 or more markers. | 2,370 | $70 | $167.9K |
| 88237 | The lab analyst performs a procedure to grow a culture of cells from bone marrow or blood in a neoplastic disorder. | 1,090 | $140 | $154K |
| 88264 | The analyst performs a chromosome analysis and analyzes 20 to 25 cells. The analysis includes counting the number of chromosomes in each cell and preparing a karyotype for each cell examined. | 1,030 | $140 | $144.7K |
Showing 1–10 of 49
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 49 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
49 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81455 | 1 | 10 | 530 | $2,850 | $1.9M |
| 81450 | 3 | 10 | 230 | $740 | $833.5K |
| 81307 | 6 | 10 | 910 | $660 | $635.4K |
| 81317 | 7 | 10 | 60 | $660 | $511.5K |
| 81298 | 7 | 10 | 60 | $630 | $489.5K |
| 81162 | 7 | 10 | 80 | $1,790 | $271.4K |
| 88185 | 2 | 20 | 690 | $20 | $265.7K |
| 88377 | 1 | 20 | 30 | $240 | $205.5K |
| 81279 | 7 | 10 | 850 | $180 | $157.2K |
| 81445 | 2 | 10 | 210 | $590 | $145.9K |
Showing 1–10 of 49
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.
32 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 153,620 | $60 | $9.1M |
| U0005 | 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, cdc or non-cdc,… | 125,050 | $20 | $2.3M |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 109,430 | $10 | $875.4K |
| 88185 | The lab analyst performs the technical component of a flow cytometry procedure using cell surface, cytoplasmic, or nuclear markers to characterize cells and aid clinicians in diagnosing patients with… | 4,450 | $140 | $614K |
| 88377 | The lab analyst applies a single multiplex in situ hybridization probe stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a… | 1,640 | $120 | $193.8K |
| 81455 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as tumor tissue or bone marrow, for DNA and possibly RNA alterations in 51 or more genes known to… | 570 | $250 | $139K |
| G2024 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen… | 12,640 | $10 | $113.7K |
| 88184 | The lab analyst performs the technical component of a flow cytometry procedure using a cell surface, cytoplasmic, or nuclear marker to characterize cells and aid clinicians in diagnosing patients… | 4,430 | $20 | $93.1K |
| 88189 | The clinician, typically a pathologist, interprets flow cytometry results of 16 or more markers. | 3,120 | $20 | $74.8K |
| 88341 | The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified… | 700 | $70 | $47.7K |
Showing 1–10 of 32
How this provider's Medicaid billing volume and revenue compare to other New Jersey providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Jersey median
32 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 12 | 130 | 3,180 | $60 | $4.2M |
| U0005 | 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, cdc or non-cdc,… | 13 | 140 | 5,590 | $20 | $823.1K |
| 81406 | The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 7 molecular pathology code. | 7 | 10 | 50 | $520 | $493.7K |
| 88185 | The lab analyst performs the technical component of a flow cytometry procedure using cell surface, cytoplasmic, or nuclear markers to characterize cells and aid clinicians in diagnosing patients with… | 3 | 20 | 410 | $180 | $462K |
| 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… | 122 | 210 | 1,660 | $60 | $347.9K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 290 | 310 | 2,240 | $1 | $184.2K |
| 81450 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as blood or bone marrow, for DNA and possibly RNA alterations in five to 50 genes known to impact… | 2 | 10 | 2,430 | $70 | $160.5K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 6 | 180 | 320 | $10 | $116.9K |
| 88377 | The lab analyst applies a single multiplex in situ hybridization probe stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a… | 1 | 10 | 470 | $120 | $97.1K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 64 | 130 | 800 | $30 | $72.6K |
Showing 1–10 of 32
Other providers in the same ZIP code as Siparadigm LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Ocean Home Health Supply, LLC | NJ | Durable Medical Equipment & Medical Supplies | $0 | $28M |
| P4 Clinical LLC | NJ | Clinical Medical Laboratory | $4.6M | $964K |
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