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NPI 1962480608 · Shelton, CT · Clinical Medical Laboratory
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Dianon Systems, Inc is a clinical medical laboratory provider located in Shelton, Connecticut. This profile covers 28 Medicare and 29 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 | 1 Forest Pkwy |
| City | Shelton |
| State | CT |
| ZIP | 06484 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | January 4, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $8.5M |
| Medicare | $4.9M |
DIANON SYSTEMS, INC presents as an anatomic pathology/clinical lab operation: the top-billed CPT/HCPCS indicate heavy activity in surgical pathology (88305, G0416), immunohistochemistry/multiplex stains (88342, 88341, 88344), in situ hybridization (88365, 88364), and cytopathology/urinary cytology techniques (88120, 88108, 88112). These procedure-level patterns (high volumes of 88305, 88120, 88342 and related codes) are consistent with a reference or centralized pathology service that performs accessioning, staining, interpretation, and advanced molecular/cytologic testing rather than low-acuity point-of-care lab work.
Medicare revenue is concentrated in a small set of high-value pathology services: the provider reports $4.9M in total Medicare revenue with the top 3 Medicare codes (88305, 88120, 88342) accounting for 65.5% of that Medicare revenue. Notably, 88305 alone is $2M (40.5% of Medicare revenue) and 88120 and 88342 contribute $813.6K (16.5%) and $416.6K (8.5%) respectively, signaling reliance on a few procedure lines for the majority of Medicare billing.
Medicaid billing is even more concentrated: DIANON reports $8.5M in total Medicaid revenue and the top 3 Medicaid codes (88305, 88312, 88120) account for 79.0% of Medicaid revenue. 88305 is dominant on Medicaid with $5.5M (64.0% of Medicaid revenue) and extremely high claim volume (143.5K claims), indicating that a single surgical pathology service is the primary driver of the provider’s Medicaid footprint.
The provider’s payer mix is Medicaid-heavy in scale: reported totals are $4.9M Medicare vs. $8.5M Medicaid, so Medicaid represents the larger single-payer revenue stream on file. This asymmetry, combined with the Medicaid concentration in a few codes, means reimbursement shifts or policy changes in state Medicaid for those specific pathology services could materially affect overall revenue.
Against peers, this lab is a clear volume outlier on many high-revenue codes. For Medicare, 88305 ranks #17 of 14580 (100th percentile; extreme outlier) and several other codes (88342, 88313, 88341) also sit at the 100th percentile or near it, indicating nationally exceptional volume in surgical pathology and related stain/interpretive services. For Medicaid, 88305 ranks #1 of 86 in-state (100th percentile; extreme outlier) and multiple other Medicaid codes (88312, 88120, 88313, 88341, 88112, 88304) similarly rank #1 in-state, which points to statewide dominance for these pathology services.
The claim-level volumes reported reinforce an operationally large processing footprint: examples include 52.4K Medicare claims for 88305 and 143.5K Medicaid claims for 88305, plus tens of thousands of claims for other stain and cytology codes on Medicaid (e.g., 27.4K claims for 88312, 22.2K for 88313). These volumes suggest centralized specimen intake and high-throughput slide preparation/staining capacity, consistent with a major reference or regional lab handling large caseloads.
Statistical descriptors provided in the source data (labels such as "extreme outlier" and "notably above typical") are consistent across payers for the same clinical services, underscoring that the provider’s exceptional volumes are not isolated to one payer. Several top codes are described as "extreme outlier" both nationally (Medicare 88305, 88342, 88313) and in-state (Medicaid 88305, 88312, 88313), reinforcing that this facility is a dominant volume center for surgical pathology and ancillary diagnostic tests rather than a marginal participant.
The provider has a long-enumerated NPI (enumerated 2006-01-04 (~20 years ago)), supporting that the high-volume pattern is established over time. Given that revenue is concentrated in a few core pathology services, the business appears stable and long-standing but also exposed to policy or rate changes that affect those specific CPT/HCPCS lines.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
28 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… | 52,440 | $40 | $2M |
| 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… | 2,030 | $400 | $813.6K |
| 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,… | 7,060 | $60 | $416.6K |
| 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,… | 6,390 | $60 | $357.7K |
| 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… | 4,150 | $50 | $219.8K |
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method | 920 | $230 | $215K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 2,890 | $70 | $196.2K |
| 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,… | 1,060 | $110 | $116.8K |
| 88108 | The analyst prepares smears of cytopathology fluids, washings, or brushings, except for cervical or vaginal fluid, using a concentration technique and interprets his findings. Cytopathology is the… | 2,060 | $50 | $92.7K |
| 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… | 2,010 | $40 | $86.4K |
Showing 1–10 of 28
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 28 CPT/HCPCS codes.
View: State1 / 2
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.
29 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… | 143,500 | $40 | $5.5M |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 27,430 | $30 | $822.9K |
| 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… | 5,680 | $80 | $448.6K |
| 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,… | 22,230 | $20 | $444.5K |
| 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,… | 14,630 | $20 | $351.2K |
| 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… | 5,510 | $40 | $225.9K |
| 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… | 9,760 | $20 | $156.2K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 15,270 | $10 | $152.7K |
| 88108 | The analyst prepares smears of cytopathology fluids, washings, or brushings, except for cervical or vaginal fluid, using a concentration technique and interprets his findings. Cytopathology is the… | 6,070 | $20 | $127.5K |
| 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,… | 1,710 | $70 | $125K |
Showing 1–10 of 29
How this provider's Medicaid billing volume and revenue compare to other Connecticut providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Connecticut median
29 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… | 1 | 90 | 3,980 | $40 | $424.8K |
| 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 | 3,030 | $70 | $226.3K |
| 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… | 9 | 10 | 650 | $80 | $188.6K |
| 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… | 9 | 10 | 630 | $60 | $132.7K |
| 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,… | 1 | 40 | 1,210 | $30 | $99.6K |
| 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,… | 2 | 50 | 1,720 | $30 | $88.3K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 1 | 50 | 470 | $40 | $86.6K |
| 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… | 29 | 40 | 780 | $30 | $64.9K |
| 88237 | The lab analyst performs a procedure to grow a culture of cells from bone marrow or blood in a neoplastic disorder. | 5 | 10 | 420 | $60 | $51.2K |
| 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. | 4 | 10 | 780 | $60 | $49K |
Showing 1–10 of 29
Other providers in the same ZIP code as Dianon Systems, Inc, ranked by combined Medicare and Medicaid revenue.
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