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NPI 1962489237 · Calabasas Hills, CA · Clinical Medical Laboratory
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Esoterix, Inc is a clinical medical laboratory provider located in Calabasas Hills, California. This profile covers 91 Medicare and 89 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 | Esoterix, Inc |
| Address | 4301 Lost Hills Rd |
| City | Calabasas Hills |
| State | CA |
| ZIP | 91301 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | December 28, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $10.3M |
| Medicaid | $4M |
ESOTERIX, INC operates as a clinical medical laboratory with a pronounced focus on specialty immunology and therapeutic drug monitoring: Medicare billing is heavily dominated by 81490, which generated $8.9M in Medicare revenue and represents 88.5% of this provider's Medicare revenue; that code ranks #1 of 20 providers nationally and is labeled an extreme outlier for national volume. Complementary Medicare activity includes high-ranked assays such as 82397 and therapeutic drug quantitation 80230, indicating lab capabilities for luminescent assays and biologic drug level testing. These code-level patterns point to an operational emphasis on algorithmic disease-activity reporting and specialty immunoassays rather than routine clinical chemistry alone.
Revenue concentration on Medicare is extremely high: the precomputed figure shows the top 3 Medicare codes account for 92.9% of the provider's total Medicare revenue, which, combined with the $10.3M total Medicare revenue on file, signals material dependency on a very small set of high-reimbursement services. In particular, 81490 alone contributes $8.9M of that sum, concentrating the provider's Medicare financial exposure in a single assay type. Analysts should treat Medicare revenue as highly concentrated around specialty tests when modeling revenue risk or growth.
By contrast, the provider's Medicaid billing shows a more distributed mix: total Medicaid revenue is $4M and the precomputed top-3 share is 51.5% of Medicaid revenue, with 81220 (CFTR mutation panel) accounting for $1.2M or 34.0% of Medicaid revenue and 86235 and 82306 contributing sizable but smaller shares. This indicates Medicaid business relies significantly on genetic testing and higher-volume endocrine and autoimmune panels, producing a broader portfolio of services compared with the Medicare book. For payers, this suggests different utilization drivers across programs: algorithmic RA scoring and specialty assays in Medicare versus genetic and high-volume hormone/autoimmune testing in Medicaid.
Payer mix is skewed toward Medicare in scale: the file shows $10.3M in Medicare revenue versus $4M in Medicaid revenue, so Medicare represents the larger portion of reported government payer revenue. This should be considered when assessing commercial contracting leverage or the financial impact of changes in Medicare reimbursement for specialty assays like 81490. Medicaid remains meaningful, however, with a concentrated Medicaid revenue source in 81220 that could affect state-level negotiations or network participation.
Competitive standing varies sharply by payer and code: nationally for Medicare, ESOTERIX is a dominant outlier on 81490 (ranks #1 of 20, 100th percentile, extreme outlier) and also shows extreme or notably above-typical volumes on codes such as 82397 (ranks #2 of 68, 99th percentile; extreme outlier) and 80230 (ranks #1 of 42, 100th percentile; extreme outlier). For state Medicaid, the provider ranks well for several codes (for example, 81220 ranks #10 of 110 in-state at the 92th percentile and 84403 ranks #9 of 236 at the 97th percentile), but 81490’s Medicaid rank (#2 of 2 in-state) indicates limited state-level presence for that specific RA algorithmic assay. Overall, the provider is a nationally significant node for a few specialized Medicare assays but a more typical high-volume participant across many Medicaid lab codes in-state.
The code mix implies distinct service lines: heavy Medicare revenue from 81490 and high national ranks on targeted therapeutic drug quantitation codes (80230, 80280) point to a lab organized around algorithmic disease-activity scoring and biologic drug monitoring for immune-mediated conditions. Medicaid revenues concentrated in 81220 (CFTR testing) and large claim counts for endocrine panels (82306, 84403) indicate an additional genetic and endocrine testing offering that drives state-program volume. Together, these patterns are consistent with a lab that combines specialized, proprietary algorithm-based assays with more commoditized high-volume endocrine and genetic testing.
Statistical outlier signals are strong and should guide due diligence: multiple codes are flagged as extreme outliers or notably above typical national volume (81490: extreme outlier; 82397 and 80230: extreme outliers; several other immunology and hormone assays listed as notably above typical). These outlier labels, coupled with high rank positions, indicate the provider captures atypically large volumes for specific specialty assays at a national level, which may materially affect benchmarking, audit sampling, and contract reviews. Analysts should weight these outlier codes more heavily when assessing utilization trends or compliance risk profiles.
The entity has long tenure in the NPI registry, enumerated on 2005-12-28 (~21 years ago), which supports interpretation of these billing concentrations as established operational patterns rather than very recent shifts. Longevity combined with concentrated specialty billing suggests these service lines are persistent elements of the provider’s business model rather than transient experiments.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
91 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81490 | The lab analyst performs the technical lab tests for 12 serum biomarker immunoassays, and carries out an algorithmic analysis using patient data and the lab test results to report a patient disease… | 10,830 | $820 | $8.9M |
| 86235 | The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,… | 17,990 | $20 | $323.7K |
| 86147 | The lab analyst performs the technical lab test to analyze for the presence of antibodies to cardiolipin, also called antiphospholipids. Report this code once for each immunoglobulin class the… | 4,630 | $30 | $115.7K |
| 82533 | The lab analyst measures the amount of total cortisol in a patient specimen. Cortisol is a steroid hormone generated from the adrenal glands. | 4,720 | $20 | $75.5K |
| 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… | 2,320 | $30 | $67.3K |
| 82523 | The lab analyst performs collagen cross–linking, a technique that he uses for various medical conditions. Collagen cross–links are reliable markers of bone resorption because they are stable in serum… | 3,310 | $20 | $59.5K |
| 83516 | The lab analyst performs the technical immunoassay test involving several steps to detect and measure an analyte of a noninfectious nature. The results show as positive or negative, or in… | 4,850 | $10 | $53.4K |
| 86160 | The lab analyst performs the technical test to measure levels of complement antigens, such as C1 through C9, that are important in detecting and fighting infection and in evaluating autoimmune… | 3,990 | $10 | $47.8K |
| 82397 | The lab analyst performs the technical lab test to analyze a specimen by mixing chemicals with the specimen, causing the analyte to become luminescent, or glow. The analyst uses the test to measure… | 3,240 | $10 | $45.4K |
| 83520 | The lab analyst measures the analyte, which is not an infectious agent antibody or infectious agent antigen, by immunoassay. Use 83520 for procedures that have no specific code assigned for the… | 2,560 | $20 | $43.6K |
Showing 1–10 of 91
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 91 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
91 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81490 | 1 | 10 | 5,780 | $820 | $4.8M |
| 86235 | 4 | 60 | 1,220 | $20 | $75.7K |
| 80299 | 2 | 10 | 260 | $20 | $62.8K |
| 83970 | 52 | 190 | 160 | $40 | $45.6K |
| 86146 | 20 | 30 | 240 | $20 | $45.3K |
| 86147 | 4 | 40 | 200 | $20 | $44.7K |
| 82306 | 31 | 490 | 100 | $30 | $44.2K |
| 84443 | 113 | 620 | 120 | $20 | $39.4K |
| 80197 | 18 | 20 | 520 | $10 | $32.2K |
| 82652 | 8 | 30 | 70 | $40 | $31.6K |
Showing 1–10 of 91
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
89 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81220 | The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR… | 5,480 | $210 | $1.2M |
| 86235 | The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,… | 7,100 | $50 | $319.3K |
| 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… | 21,260 | $10 | $276.3K |
| 84403 | The lab analyst performs a test to measure total testosterone, typically in patient serum. | 14,510 | $20 | $261.2K |
| 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… | 13,510 | $10 | $135.1K |
| 86147 | The lab analyst performs the technical lab test to analyze for the presence of antibodies to cardiolipin, also called antiphospholipids. Report this code once for each immunoglobulin class the… | 3,430 | $40 | $133.9K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 21,070 | $10 | $126.4K |
| 81490 | The lab analyst performs the technical lab tests for 12 serum biomarker immunoassays, and carries out an algorithmic analysis using patient data and the lab test results to report a patient disease… | 2,030 | $60 | $117.7K |
| 82397 | The lab analyst performs the technical lab test to analyze a specimen by mixing chemicals with the specimen, causing the analyte to become luminescent, or glow. The analyst uses the test to measure… | 13,180 | $10 | $92.3K |
| 84439 | The lab analyst performs a test to measure free thyroxine, or free T4, typically in patient serum. | 15,990 | $10 | $80K |
Showing 1–10 of 89
How this provider's Medicaid billing volume and revenue compare to other California providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. California median
89 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81220 | The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR… | 10 | 110 | 190 | $140 | $1.6M |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 291 | 340 | 970 | $40 | $343.6K |
| 81490 | The lab analyst performs the technical lab tests for 12 serum biomarker immunoassays, and carries out an algorithmic analysis using patient data and the lab test results to report a patient disease… | 2 | 10 | 3,220 | $70 | $231.8K |
| 82542 | The lab analyst performs the technical lab test to evaluate the specimen for the presence or amount of a nondrug analyte by using column chromatography and possibly mass spectrometry. | 7 | 30 | 170 | $30 | $197.6K |
| 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. | 1,478 | 1,720 | 1,360 | $10 | $165.3K |
| 86235 | The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,… | 10 | 130 | 280 | $20 | $85.9K |
| 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… | 1,334 | 2,100 | 1,130 | $1 | $83.5K |
| 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… | 101 | 1,360 | 590 | $10 | $74.1K |
| 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… | 31 | 1,110 | 300 | $10 | $70.2K |
| 80197 | The lab analyst performs the technical lab test to analyze a specimen to quantitate the total amount of tacrolimus present, which is an immunosuppressant drug patients often use to prevent rejection… | 68 | 90 | 1,050 | $10 | $61.1K |
Showing 1–10 of 89
Other providers in the same ZIP code as Esoterix, Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Pacgenomics | CA | Clinical Medical Laboratory | $1.6M | $12.9M |
| Payam Abrishami | CA | Dermatology Physician | $1.4M | $0 |
| Robert Dye | CA | Procedural Dermatology Physician | $1.1M | $0 |
| Shauna Papenbrook | CA | Clinical Psychologist | $514.8K | $0 |
| Kim Barrus | CA | Psychologist | $370.3K | $630 |
| Shannon Dobbs | CA | Clinical Psychologist | $261.8K | $0 |
| Neil Steinberg | CA | Podiatrist | $67.2K | $0 |
| Mark Hestrin | CA | Anesthesiology Physician | $43.6K | $0 |
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