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NPI 1992812473 · Beltsville, MD · Clinical Medical Laboratory
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Theranostix Inc is a clinical medical laboratory provider located in Beltsville, Maryland. This profile covers 108 Medicare and 64 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 | Theranostix Inc |
| Address | 8000 Virginia Manor Rd |
| City | Beltsville |
| State | MD |
| ZIP | 20705 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | August 23, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $5.3M |
| Medicare | $5.1M |
THERANOSTIX INC functions as a high-volume clinical medical laboratory with nearly equal lifetime scale across payers, reporting Total Medicare revenue: $5.1M and Total Medicaid revenue: $5.3M. Its NPI has been enumerated since 2006-08-23 (~20 years ago), indicating long-standing presence in the market that supports both fee-for-service Medicare and state Medicaid billing streams.
Surgical pathology and slide-based diagnostic services are a primary business line. The surgical pathology code 88305 appears as the single largest revenue driver on both payers (Medicare: 21.1K claims, $822.9K revenue; Medicaid: 22.6K claims, $1.5M revenue) and is identified as an extreme outlier nationally for Medicare and in-state for Medicaid, consistent with a lab that handles very large volumes of tissue accessioning, grossing and microscopic interpretation.
Immunohistochemistry and special staining are also core services. High Medicare revenues for 88313 ($482.2K, 7K claims) and 88342 ($362K, 5.2K claims), both flagged as extreme outliers nationally, plus large Medicaid volumes for 88313 ($639.7K, 12.3K claims) and 88342 ($618.7K, 11.9K claims), indicate substantial IHC and special-stain processing and interpretation capacity beyond routine anatomic pathology.
Molecular and genetic testing are a distinct service line in Medicare billing. STR-related codes 81266 ($495.6K, 1.7K claims) and 81265 ($384.4K, 1.7K claims) together are sizable Medicare drivers and each ranks #1 among very small peer pools nationally, signaling that the provider offers specialized genetic/zygosity testing or reference-level STR services.
High-throughput infectious-disease nucleic acid testing is a major Medicaid revenue contributor. U0003 on Medicaid (24.5K claims, $1.4M revenue) and U0005 (13.1K claims, $182.8K revenue) plus Medicare use of 87798 (14.3K claims, $487.4K revenue) point to extensive amplified-probe PCR activity; on Medicaid U0003 is a top code accounting for a large share of revenue and ranks in the 90th percentile in-state.
Revenue concentration differs sharply by payer: the precomputed top 3 Medicare codes account for 38.4% of this provider's total Medicare revenue, while the precomputed top 3 Medicaid codes account for 68.8% of its total Medicaid revenue. That contrast indicates Medicaid revenue is highly concentrated in a small set of services (notably 88305 and U0003), whereas Medicare revenue is more distributed across pathology, immunostaining and molecular codes.
Competitive standing is prominent for several codes at different geographic scales. For Medicare, 88305, 88313 and 88342 are listed as extreme outliers at very high national percentiles (e.g., 88305 ranks #67 of 14580 nationally, 88313 ranks #12 of 6757), and STR codes 81265/81266 rank #1 within very small national peer sets; for Medicaid the same pathology codes rank among the top in-state (88305 #5 of 123, 88313 #2 of 38, 88342 #2 of 68), indicating the provider is a major state-level player for both histopathology and certain molecular services.
The code-level reimbursement profile supports a throughput-driven operating model: many high-volume infectious and screening codes have relatively low average paid-per-claim amounts (examples: Medicare 87798 avg paid/claim $34; Medicare U0003 avg paid/claim $74; Medicaid U0003 avg paid/claim $57), while specialized genetic and pathology codes carry higher per-claim payments (examples: Medicare 81266 avg paid/claim $298; Medicare 81265 avg paid/claim $228). This mix is consistent with a lab combining high-volume, lower-margin PCR testing with higher-margin specialty molecular and pathology services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
108 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… | 21,100 | $40 | $822.9K |
| 81266 | In addition to the 81265 service, the lab analyst performs the technical lab test to evaluate Short Tandem Repeat, or STR, markers to compare genetic similarity in the patient and an additional… | 1,660 | $300 | $495.6K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 14,340 | $30 | $487.4K |
| 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,… | 6,990 | $70 | $482.2K |
| 81265 | The lab analyst performs the technical lab test to evaluate Short Tandem Repeat, or STR, markers to compare genetic similarity in the patient and a specimen from another person. | 1,690 | $230 | $384.4K |
| 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,… | 5,170 | $70 | $362K |
| 88121 | The lab analyst performs a technical lab test on a urinary tract specimen using in situ hybridization and three to five molecular probes for computer assisted morphometric analysis, looking at the… | 680 | $380 | $257.4K |
| 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… | 2,930 | $90 | $251.9K |
| 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… | 570 | $360 | $205.1K |
| 87506 | The lab analyst performs a test to detect six to eleven types or subtypes of a pathogen, such as Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia, that cause gastrointestinal… | 560 | $260 | $143.7K |
Showing 1–10 of 108
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 108 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
108 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81266 | 1 | 10 | 1,660 | $300 | $496.1K |
| 81265 | 1 | 10 | 1,690 | $230 | $384.1K |
| 87798 | 4 | 60 | 1,430 | $30 | $170.3K |
| G0471 | 4 | 10 | 640 | $10 | $142.9K |
| 88121 | 1 | 10 | 370 | $390 | $142.5K |
| 87506 | 2 | 10 | 210 | $260 | $96.7K |
| 88120 | 1 | 10 | 70 | $460 | $64.3K |
| 88305 | 3 | 270 | 490 | $40 | $61.4K |
| 87563 | 2 | 10 | 510 | $30 | $58.5K |
| 81298 | 2 | 10 | 80 | $630 | $51K |
Showing 1–10 of 108
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.
64 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… | 22,570 | $70 | $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… | 24,470 | $60 | $1.4M |
| 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,… | 12,300 | $50 | $639.7K |
| 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,… | 11,900 | $50 | $618.7K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 4,540 | $50 | $222.4K |
| 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,… | 13,060 | $10 | $182.8K |
| 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… | 4,810 | $30 | $144.2K |
| 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… | 3,970 | $20 | $91.3K |
| 87150 | The lab analyst performs an analysis using amplified DNA or RNA probe technique on a previously isolated and identified organism to categorize the organism more specifically, such as to the taxonomic… | 770 | $60 | $46.4K |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 1,550 | $30 | $41.8K |
Showing 1–10 of 64
How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland median
64 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… | 9 | 80 | 500 | $70 | $691.2K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 27 | 50 | 660 | $30 | $289.2K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 27 | 50 | 640 | $30 | $284.4K |
| 87506 | The lab analyst performs a test to detect six to eleven types or subtypes of a pathogen, such as Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia, that cause gastrointestinal… | 3 | 10 | 190 | $240 | $247.5K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 24 | 30 | 550 | $20 | $244.7K |
| 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… | 5 | 120 | 850 | $60 | $186.4K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 22 | 30 | 1,010 | $20 | $152.5K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 5 | 40 | 320 | $50 | $146.1K |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 6 | 30 | 120 | $50 | $132.4K |
| 87633 | The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for… | 22 | 30 | 60 | $250 | $122.1K |
Showing 1–10 of 64
Other providers in the same ZIP code as Theranostix Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Frontline Community Services Inc | MD | Case Management Agency | $0 | $100.8M |
| Worldshine Care LLC | MD | Adult Day Care Clinic/Center | $0 | $24.3M |
| Rose Oma | MD | Speech-Language Pathologist | $0 | $20.8M |
| Heartland Hospice Services LLC | MD | Community Based Hospice Care Agency | $0 | $20.6M |
| Alight Supports, Inc | MD | Developmental Disabilities Clinic/Center | $0 | $8M |
| Patient First Maryland Medical Group PLLC | MD | Family Medicine Physician | $0 | $4.8M |
| Tehmina Ali | MD | Anatomic Pathology Physician | $1.7M | $0 |
| Mobile Medical Imaging, LLC | MD | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | $782.2K | $126.5K |
| Ayim Akyea Djamson | MD | Specialist | $622.3K | $0 |
| Georgina Johns | MD | Family Nurse Practitioner | $268.9K | $0 |
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