Loading...
NPI 1932849890 · Irving, TX · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Maxcare Diagnostics is a clinical medical laboratory provider located in Irving, Texas. This profile covers 1 Medicare and 3 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 | Maxcare Diagnostics |
| Address | 3301 Conflans Rd Ste 107 |
| City | Irving |
| State | TX |
| ZIP | 75061 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | March 30, 2022 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $13.6M |
| Medicaid | $1.5M |
MAXCARE DIAGNOSTICS presents as a high-volume clinical medical laboratory focused on multiplex respiratory pathogen testing: Medicare billing is dominated by 87637 (the multiplex SARS‑CoV‑2/Influenza A/Influenza B/RSV NAAT), which appears with 97.6K Medicare claims, $140 avg paid/claim and $13.7M revenue, signaling large-scale diagnostic throughput rather than a diverse outpatient testing mix. The same multiplex test also dominates Medicaid billing with 17.1K claims, $87 avg paid/claim and $1.5M revenue, reinforcing that the lab’s core service line is centralized respiratory multiplex NAAT.
Revenue concentration is extreme for both payers: the precomputed top‑3 Medicare codes account for 100.0% of the provider’s Medicare revenue, and the precomputed top‑3 Medicaid codes account for 100.0% of Medicaid revenue, indicating virtually all reported reimbursement derives from a very narrow set of high-volume test codes. This degree of concentration implies business exposure to reimbursement changes or demand shifts for those specific respiratory assays.
The provider’s payer mix is heavily Medicare-skewed in scale: lifetime Medicare revenue on file is $13.6M versus $1.5M in Medicaid revenue, so Medicare represents the dominant revenue stream by an order of magnitude and Medicaid is a much smaller contributor to total billed dollars. Analysts should treat Medicaid activity as secondary when modeling the provider’s financial exposure or market reach.
MAXCARE’s Medicare position on its principal code is nationally exceptional: 87637 ranks #1 of 1,141 providers nationally and is labeled an "extreme outlier, far above typical national volume for this code," which characterizes the lab as a dominant national supplier of multiplex respiratory NAAT to Medicare patients or suppliers. That single-code dominance on Medicare suggests the provider operates at an unusually large scale for that specific diagnostic service.
By contrast, Medicaid competitive standing is strong but described differently: the Medicaid instance of 87637 generates $1.5M (99.3% of this provider’s Medicaid revenue) and ranks #3 of 122 providers in-state (98th percentile), yet the record characterizes this Medicaid volume as "typical, unremarkable volume for this code," indicating the in-state market includes several high-volume labs and that MAXCARE’s Medicaid activity fits within normal state-level variation. This nuance matters for market-share assessments within Texas.
Medicaid billing includes minor supplemental SARS‑CoV‑2 test codes: U0003 (302 claims, $25 avg paid/claim, $7.6K revenue, 0.5% of Medicaid revenue, rank #182 of 337 in-state, 46th percentile) and U0005 (287 claims, $8 avg paid/claim, $2.3K revenue, 0.2% of Medicaid revenue, rank #160 of 257 in-state, 38th percentile). Those small volumes and low average payments indicate ancillary use of high-throughput or expedited reporting codes but do not materially move the provider’s Medicaid revenue profile.
The provider has a relatively recent NPI enumeration date of 2022-03-30 (~4 years ago), so its rapid ascension to extreme Medicare volume on 87637 has occurred over a short operational window. That tenure suggests the lab scaled quickly into high-throughput respiratory testing capacity after enumeration, which is relevant for capacity, capital expenditure and contracting timelines.
Operational and pricing signals point to a high-throughput, payer-differential model: the same multiplex test shows materially different avg paid/claim levels across payers ($140 avg paid/claim on Medicare vs $87 avg paid/claim on Medicaid for 87637), and the observed claim counts (97.6K Medicare claims and 17.1K Medicaid claims) are consistent with centralized, high-volume processing rather than low-throughput point-of-care testing. Analysts should consider throughput and payer-specific reimbursement when projecting margins or negotiating contracts.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 97,560 | $140 | $13.7M |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
1 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87637 | 1 | 70 | 40 | $140 | $404.2K |
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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 17,050 | $90 | $1.5M |
| 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… | 300 | $30 | $7.5K |
| 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,… | 290 | $10 | $2.3K |
How this provider's Medicaid billing volume and revenue compare to other Texas providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Texas median
3 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… | 182 | 340 | 400 | $50 | $553.5K |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 3 | 120 | 340 | $120 | $422K |
| 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,… | 160 | 260 | 640 | $20 | $137.2K |
Other providers in the same ZIP code as Maxcare Diagnostics, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Baylor Medical Center At Irving | TX | General Acute Care Hospital | $0 | $13.3M |
| Steve Perkins | TX | Hematology & Oncology Physician | $1M | $0 |
| Madelin Perez Antela | TX | Family Nurse Practitioner | $332.4K | $0 |
| Robert Bayless | TX | Orthopaedic Surgery Physician | $226.4K | $0 |
| Richard Roberts | TX | Orthopaedic Surgery Physician | $212.6K | $0 |
| Steven Sanders | TX | Orthopaedic Surgery Physician | $203.2K | $0 |
| Yong Pak | TX | Pain Medicine (Physical Medicine & Rehabilitation) Physician | $190.3K | $0 |
| Narotham Thudi | TX | Hematology & Oncology Physician | $179.3K | $0 |
| Gary Erwin | TX | Critical Care Medicine (Internal Medicine) Physician | $163.7K | $0 |
| Zachary Compton | TX | Urology Physician | $127.5K | $0 |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.