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NPI 1912997354 · Oklahoma City, OK · Clinical Medical Laboratory
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Dianon Systems Inc is a clinical medical laboratory provider located in Oklahoma City, Oklahoma. This profile covers 47 Medicare and 33 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 | Dianon Systems Inc |
| Address | 840 Research Pkwy |
| City | Oklahoma City |
| State | OK |
| ZIP | 73104 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | October 26, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.5M |
| Medicaid | $1.3M |
This provider’s Medicare revenue ($2.5M) exceeds its Medicaid revenue ($1.3M), indicating Medicare is the larger payer by dollar volume for DIANON SYSTEMS INC rather than a single‑payer operation. Both payers appear relevant to the business, but Medicare represents the primary source of fee‑for‑service revenue.
Revenue concentration is high on the Medicare side: the precomputed top 3 Medicare codes account for 76.9% of this provider's total Medicare revenue, driven by G0416 (818.3K revenue; 3.6K claims; $227 avg paid/claim; 33.6%), 88120 (668.3K revenue; 1.9K claims; $345 avg paid/claim; 27.4%), and 88112 (386.3K revenue; 11.7K claims; $33 avg paid/claim; 15.9%). That concentration implies that changes in reimbursement or referral patterns for these specific pathology/cytology and prostate biopsy services would materially affect Medicare revenue.
Medicaid revenue is also concentrated: the precomputed top 3 Medicaid codes account for 73.8% of this provider's total Medicaid revenue, dominated by 88305 (624.1K revenue; 3.3K claims; $189 avg paid/claim; 49.5%), followed by 88112 (180.7K revenue; 7.9K claims; $23 avg paid/claim; 14.3%) and 88120 (125.6K revenue; 1.6K claims; $80 avg paid/claim; 10.0%). This pattern shows Medicaid dollars are driven largely by surgical pathology (88305) with cytology and molecular cytogenetic testing contributing meaningful secondary shares.
The code mix points to a specialized pathology/clinical laboratory operation with a clear focus on surgical pathology and cytopathology plus urologic testing: G0416 is listed as a top Medicare code for prostate needle biopsy services, 88305 is the largest Medicaid revenue driver for level IV surgical pathology, and both 88112 and 88120 (cytopathology and in‑situ hybridization) are major contributors across payers. PSA testing codes (84153, 84154) and multiple urine/metabolic codes (e.g., 82355, 82340, 84392) further indicate a meaningful volume of urologic and metabolic stone-related testing in the overall service mix.
On competitive standing, DIANON SYSTEMS INC is a national outlier for several Medicare codes: G0416 ranks #1 of 2465 providers nationally (100th percentile; extreme outlier, far above typical national volume for this code) and 88112 ranks #3 of 4868 providers nationally (100th percentile; extreme outlier). 88120 also ranks highly at #5 of 232 (98th percentile; notably above typical national volume for this code), signaling dominance or very concentrated referral relationships for specific pathology and molecular cytology services at the national level.
Within Oklahoma Medicaid, the provider shows leading or unique positioning for multiple codes: 88112 ranks #1 of 9 in‑state (100th percentile; notably above typical state volume), while 88305 is the top Medicaid revenue code but ranks #12 of 50 in‑state (78th percentile; typical, unremarkable volume). Several chemistry/urine and specialty codes in the Medicaid list are reported as rank #1 of 1 with no state peer comparison available (e.g., 88120, 82507, 83945), which suggests DIANON may be the sole or dominant in‑state supplier for those specific tests.
High absolute claim volumes and mixed payment profiles underscore different revenue dynamics across codes: 88112 shows very large claim volume on Medicare (11.7K claims; $33 avg paid/claim) while 88120 on Medicare has fewer claims but a high avg paid/claim ($345 avg paid/claim; 1.9K claims), and G0416 produces substantial Medicare revenue at 3.6K claims and $227 avg paid/claim. Those contrasting drivers—high volume/low unit price versus lower volume/higher unit price—suggest the lab’s economics depend both on scale for routine cytology and on selective higher‑value pathology/molecular procedures.
The provider has an established enrollment history (NPI enumerated 2005-10-26 (~21 years ago)), and that tenure combined with the extreme outlier ranks on key national Medicare codes implies a long‑standing, specialized lab footprint rather than a recent entrant. For payers and network planners, the combination of longevity, concentrated revenue by a few high‑impact codes, and top national rankings points to a stable, specialist pathology partner whose referral patterns and reimbursement changes should be monitored closely.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
47 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method | 3,610 | $230 | $818.3K |
| 88120 | The lab analyst performs a technical lab test on a urinary tract specimen using in situ hybridization and three to five molecular probes for manual morphometric analysis, looking at the number and… | 1,940 | $350 | $668.3K |
| 88112 | Selective cellular enhancement for cytopathology, such as the method of using a liquid–based slide preparation, uses a liquid–based medium to collect samples and preserve cells which can aid in… | 11,710 | $30 | $386.3K |
| 82507 | The lab analyst measures the amount of citrate in a patient specimen. Citrate is the conjugate base of citric acid. | 2,590 | $30 | $70K |
| 88344 | The lab analyst applies a single multiplex antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 590 | $110 | $64.6K |
| 88307 | The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 320 | $190 | $61K |
| 84153 | The lab analyst performs testing for total prostate specific antigen, PSA, typically on serum or plasma samples using laboratory analyzers. PSA is a protein the prostate gland produces, and… | 2,590 | $20 | $46.7K |
| 83945 | The lab analyst measures the oxalate level, commonly in a 24 hour urine specimen. Oxalate is a substance commonly present in certain vegetables and nuts. Oxalate is also present in normal urine… | 2,590 | $10 | $36.3K |
| 82127 | The lab analyst determines the presence of a single amino acid in the specimen, such as blood, plasma, urine, amniotic fluid, or cerebrospinal fluid. The usual screen is for the presence of an amino… | 2,550 | $10 | $35.6K |
| 82355 | The lab analyst performs a qualitative analysis on the calculus for the presence of a variety of substances, usually calcium, carbonate, cystine, magnesium, oxalate, phosphates, and urates. A… | 3,160 | $10 | $34.7K |
Showing 1–10 of 47
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 47 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
47 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 88120 | 1 | 10 | 1,940 | $350 | $668.9K |
| 83970 | 10 | 20 | 170 | $40 | $47.2K |
| 88305 | 49 | 100 | 680 | $30 | $43.2K |
| G0416 | 1 | 30 | 20 | $210 | $38.1K |
| 82127 | 1 | 10 | 2,550 | $10 | $35.4K |
| 82507 | 1 | 10 | 90 | $30 | $19.2K |
| 82355 | 1 | 10 | 1,600 | $10 | $18.2K |
| 88112 | 1 | 30 | 90 | $30 | $15.6K |
| 88344 | 1 | 30 | 80 | $90 | $13K |
| 80053 | 225 | 280 | 100 | $10 | $12.4K |
Showing 1–10 of 47
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.
33 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 3,300 | $190 | $624.1K |
| 88112 | Selective cellular enhancement for cytopathology, such as the method of using a liquid–based slide preparation, uses a liquid–based medium to collect samples and preserve cells which can aid in… | 7,860 | $20 | $180.7K |
| 88120 | The lab analyst performs a technical lab test on a urinary tract specimen using in situ hybridization and three to five molecular probes for manual morphometric analysis, looking at the number and… | 1,570 | $80 | $125.6K |
| 82507 | The lab analyst measures the amount of citrate in a patient specimen. Citrate is the conjugate base of citric acid. | 4,870 | $10 | $63.3K |
| 83945 | The lab analyst measures the oxalate level, commonly in a 24 hour urine specimen. Oxalate is a substance commonly present in certain vegetables and nuts. Oxalate is also present in normal urine… | 4,900 | $10 | $34.3K |
| 82127 | The lab analyst determines the presence of a single amino acid in the specimen, such as blood, plasma, urine, amniotic fluid, or cerebrospinal fluid. The usual screen is for the presence of an amino… | 4,810 | $10 | $33.7K |
| 82355 | The lab analyst performs a qualitative analysis on the calculus for the presence of a variety of substances, usually calcium, carbonate, cystine, magnesium, oxalate, phosphates, and urates. A… | 4,290 | $10 | $21.4K |
| 82340 | The lab analyst performs the technical lab test to analyze the quantitative value of calcium in the timed urine specimen. | 4,920 | $1 | $19.7K |
| 83735 | The lab analyst performs a test to measure the amount of magnesium in a patient specimen. | 4,860 | $1 | $19.4K |
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method | 430 | $40 | $16.7K |
Showing 1–10 of 33
How this provider's Medicaid billing volume and revenue compare to other Oklahoma providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Oklahoma median
33 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 12 | 50 | 550 | $60 | $235.1K |
| 88120 | The lab analyst performs a technical lab test on a urinary tract specimen using in situ hybridization and three to five molecular probes for manual morphometric analysis, looking at the number and… | 1 | 10 | 1,570 | $80 | $125.4K |
| 82507 | The lab analyst measures the amount of citrate in a patient specimen. Citrate is the conjugate base of citric acid. | 1 | 10 | 4,870 | $10 | $64.3K |
| 84403 | The lab analyst performs a test to measure total testosterone, typically in patient serum. | 18 | 20 | 510 | $20 | $55.5K |
| 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. | 13 | 20 | 90 | $10 | $48.6K |
| 87186 | The lab analyst performs the technical steps to evaluate a culture isolate’s susceptibility, or sensitivity, to multiple antimicrobial agents, commonly called antibiotics, by observing growth of the… | 11 | 20 | 130 | $10 | $44K |
| 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,… | 7 | 20 | 100 | $70 | $35K |
| 82127 | The lab analyst determines the presence of a single amino acid in the specimen, such as blood, plasma, urine, amniotic fluid, or cerebrospinal fluid. The usual screen is for the presence of an amino… | 1 | 10 | 4,810 | $10 | $33.7K |
| 87086 | Culture, bacterial; quantitative, colony count, urine. | 40 | 70 | 360 | $10 | $32.6K |
| 88112 | Selective cellular enhancement for cytopathology, such as the method of using a liquid–based slide preparation, uses a liquid–based medium to collect samples and preserve cells which can aid in… | 1 | 10 | 260 | $20 | $32.5K |
Showing 1–10 of 33
Other providers in the same ZIP code as Dianon Systems Inc, ranked by combined Medicare and Medicaid revenue.
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