All Other Ambulatory Health Care Services (U.S.) — Rollup Primer

NAICS 2022 code 62199. A Histometrics primer for public- and private-market investors.

NAICS = North American Industry Classification System, the U.S. government's standard for grouping businesses by their primary activity. This is a NAICS industry (5-digit) — one level up from the two 6-digit industries it contains. It sits under industry group 6219, Other Ambulatory Health Care Services, whose only other member is 621910, Ambulance Services (covered separately). "Ambulatory" simply means care delivered without an overnight hospital stay.

1. Overview

NAICS 62199 is the government's "everything else" drawer for outpatient health services that don't fit any named category — after physician offices, dentists, labs, outpatient centers, home health, and ambulances have all been filed elsewhere. It holds just two child industries, and the striking fact about this level is how little they have in common:

• 621991 — Blood and Organ Banks. A small number of large, capital-intensive, heavily regulated operators that collect, test, process, store, and distribute human biological materials — whole blood, source plasma, transplant organs, and specialty banks (cord blood, sperm, eggs, eye/tissue). Ownership is split down the middle between nonprofits (the American Red Cross, community blood centers, organ procurement organizations) and a fast-growing for-profit plasma complex feeding the plasma-medicines industry.[3]
• 621999 — All Other Miscellaneous Ambulatory Health Care Services. A vast crowd of small private service businesses: workplace drug testing, biometric and community health screening, mobile and in-home exams, remote cardiac/pacemaker monitoring, smoking-cessation programs, and medical case management. A dozen loosely related niches that share nothing except being too small to earn their own codes.[3]

For an investor the honest takeaway is that 62199 is not a theme you can buy — it is a filing convention. The two children barely touch operationally; pooling them does not create a market with one demand curve, one margin profile, or one obvious public vehicle. The value of looking at them together is the contrast: it shows where in this drawer the money, the growth, and the ownable assets actually sit. Neither child offers a clean public pure-play. Public exposure to 621991 runs almost entirely through the plasma-and-plasma-medicines and organ-technology companies one step up- or downstream; public exposure to 621999 runs through focused names (remote cardiac monitoring, case management, occupational health) or small segments of diagnostics, device, and managed-care majors. The bulk of both industries — nonprofit blood/organ operators on one side, thousands of small screening and testing shops on the other — is not ordinary common equity at all.

Combined reported federal receipts for the level were about $45.3 billion (2022) [1]. That figure understates the true economic system, for reasons in Section 3.

2. What's inside — the two children and how they differ

All share and per-firm figures below are computed from our ground-truth federal statistics for this level and its children; they are the distinctive value of a rollup view.[1][2][4][5][6][7]

The one-line contrast. 621991 is few, large, and capital-heavy — 18% of the sites earn 44% of the revenue, at roughly $54 million per firm — because handling human biological materials demands scale, licensure, and cold-chain logistics. 621999 is many, tiny, and labor-light — 82% of the sites for 56% of the revenue, at roughly $3.5 million per firm. One drawer, two opposite economic shapes.

Why they're filed together (and why that's misleading). NAICS is a residual hierarchy: after every named ambulatory activity is assigned, both blood/organ banking and "miscellaneous other" land in the leftover 5-digit bucket. That accounting convenience does not make them a comparable market. The rest of this primer treats them as two distinct opportunity sets under one label.

3. How big it is

Our ground-truth federal figures for NAICS 62199 combine the 2022 Economic Census (receipts, firms, concentration) with 2023 County Business Patterns (CBP: establishments, employment, payroll). The years and survey programs differ, so the two blocks are not a single snapshot.[1][2]

(CRn = combined revenue share of the n largest firms. HHI = sum of squared market shares; a lower number means less concentrated. U.S. antitrust agencies treat a market above 1,800 as "highly concentrated," so at 161.4 this level sits more than an order of magnitude below that line.[30])

Reading the concentration. The level HHI of 161.4 is actually lower than either child's HHI — combining two industries whose leaders don't overlap dilutes every firm's share. Likewise the level CR4 (20.5%) falls below both children's CR4, because the largest blood/plasma firms and the largest miscellaneous-services firms are different companies. The pooled picture is therefore more fragmented than either part, which is another way of saying no single company is large in "62199" as a whole. The 7,638 firms running 11,637 establishments (the two children's firm counts, 371 + 7,270, are essentially additive) tell the same story: a handful of multi-site operators on the blood side, a long tail of one- and two-site shops on the other.

Undercount and scope caveats — read before quoting the $45.3B:

1. The profit lives next door (621991 side). The high-value activity — turning collected plasma into immunoglobulin (IG), albumin, and clotting factors — is booked as pharmaceutical manufacturing (NAICS 325414), not here. And nonprofit blood centers and organ procurement organizations price on cost recovery, not margin, so their receipts reflect processing fees, not the clinical value of blood or the profit in downstream medicines.[3][10][11]
2. Nonemployers and spillover (621999 side). The federal counts above are an employer-business frame: they exclude sole proprietors with no payroll, businesses without an employer identification number, and most government establishments. And because 621999 is itself a residual bucket, much of its underlying activity (drug-test analysis, screenings run by hospitals or physician groups, monitoring billed by cardiology practices) is captured under other codes — labs, physician offices, hospitals, device makers.[3][5]
3. No fine-grained federal splits. Our ground-truth data give no blood-versus-organ breakout, no capacity, pricing, margin, or growth series for the level, and no public/nonprofit/government ownership split. None should be inferred; where a value is suppressed we do not state one. We have no official growth rate for 62199 — the "direction of travel" above is qualitative, drawn from the child industries.

Treat ~$45.3B as a floor for the collection-and-services layer, with the real economic system — plasma medicines especially — materially larger once downstream activity is added.

4. The investable universe — where value concentrates across the children

There is no exchange-traded fund or clean public proxy for NAICS 62199, and none for either child. Value concentrates in very different places on each side. Figures below are recent reported scale, not recommendations; tickers and multiples are reserved for this and the how-to-invest section. An ADR (American depositary receipt) is a U.S.-traded certificate representing shares of a foreign company; OTC = over-the-counter.

Side A — 621991 (blood/organ): value sits up- and downstream of the banks themselves. The banks that make up the industry are largely nonprofit and unbuyable; the money is in the medicines and the tools.

The nonprofit and private core — the American Red Cross, community centers (Vitalant, OneBlood, Versiti), the ~56 federally designated organ procurement organizations, and private cord-blood/plasma operators (Octapharma, KedPlasma, ImmunoTek) — supplies most of the actual blood, organs, and feedstock but offers no ordinary common-equity ownership; the accessible private assets are for-profit plasma collection and cord-blood businesses.[9][19][20]

Side B — 621999 (miscellaneous): value sits in a few focused niches and small segments of larger firms.

Most of 621999 is private: PE-backed roll-ups such as Life Line Screening (consumer screening), DISA (drug-test administration), Premise Health and Examinetics (occupational health), Enlyte/Genex (workers'-comp case management), and Matrix Medical (in-home assessments).[24][25][28]

The synthesis. On Side A the ownable value is adjacent to the industry (medicines, equipment, organ tech); on Side B it is inside the industry but scattered across niche operators and diversified parents. In both cases you are buying a slice, never "the industry."

5. How the money works

The two children run on unrelated economic engines; there is no common unit for the level.

621991 — four distinct models:

• Community blood banking (nonprofit). Free donors; revenue is a per-unit cost-recovery fee to hospitals for each processed component, on sticky 3–5-year contracts. High fixed costs against a perishable product and structurally declining transfusion volume push margins narrow or negative — a scale-or-merge business.[3][31]
• Source plasma → medicines (for-profit). The growth engine. Paid donors (often $50–$120 per visit, up to twice weekly) let the U.S. collect roughly 70% of the world's source plasma; economics are those of a raw-material feedstock feeding high-margin IG.[3][10]
• Organ procurement (nonprofit, cost-reimbursed). ~56 organ procurement organizations act as geographic monopolies paid a "standard acquisition charge" per organ; selling organs is a federal crime, so performance is measured in organs recovered, not dollars.[3][20]
• Cord-blood banking (subscription-like). Upfront fee plus recurring annual storage.[19]

621999 — transactional service fees: revenue is fundamentally volume × price per test, encounter, monitoring study, or case, paid by employers (drug testing, occupational health), payers/Medicare (cardiac monitoring, via CPT reimbursement codes), per-member-per-month contracts (care management), workers'-comp fee schedules, or consumers (screening packages). The main cost is clinical labor; the interpretation/software layer can be high-margin, but sales-and-marketing to win employer, cardiologist, and payer relationships thins operating margins.[3][23]

Reflecting the labor mix, average pay runs ~$58,600 per employee on the blood/organ side versus ~$69,400 on the miscellaneous side [2][6][7] — the latter carries proportionally more clinical and professional staff.

6. What drives demand

• Aging population and chronic disease lift both sides: more transfusion candidates, arrhythmia detection, preventive screening, and coordinated care outside hospitals.[23]
• Immunoglobulin (IG) demand is the single biggest growth driver anywhere in this level — expanding immunodeficiency diagnosis plus new neurology/autoimmune indications pull plasma volumes higher. On the plasma side, supply (donor turnout, throughput per center), not demand, is usually the ceiling.[10][11]
• Blood demand is essential but flat-to-soft: patient blood management transfuses less per procedure, so the swing factor is donor turnout, and shortages recur.[3][31]
• Organs: demand vastly exceeds supply (a six-figure transplant waiting list); growth comes from more donors and from preservation technology that keeps more organs usable, supporting record transplant volumes.[20][21]
• Employment and regulatory mandates drive 621999's testing niches: hiring levels set drug-screen volume, while DOT-regulated transportation must test safety-sensitive workers — a durable floor.[27]
• Cannabis liberalization is a genuine headwind to the drug-testing niche as states bar pre-employment marijuana screening.[32]

7. Regulation

Regulation is set by the activity, not the shared code, and the two children face almost entirely different regimes.

• 621991 (blood/organ): The FDA's Center for Biologics Evaluation and Research is the primary regulator of blood and plasma (21 CFR Parts 600–680); source-plasma operators need a biologics license, and AABB accreditation is a de-facto requirement. Organs are regulated separately — not by the FDA but by the Health Resources and Services Administration's Organ Procurement and Transplantation Network, with CMS Conditions for Coverage that can decertify an underperforming organ procurement organization. Selling organs is barred by the National Organ Transplant Act.[20][21][22]
• 621999 (miscellaneous): Workplace drug testing follows SAMHSA/DOT rules (49 CFR Part 40; forensic testing needs a SAMHSA-certified lab); lab steps fall under CLIA; cardiac monitors need FDA 510(k) clearance; reimbursement is governed by CMS/CPT; and billing/coding exposure runs through the Anti-Kickback Statute, False Claims Act, and Stark law. A June 2026 DOJ settlement over in-home-assessment diagnosis coding shows the enforcement risk is live.[26][27][28]

Both children are, in short, high-compliance industries — but an investor must underwrite the specific regime (biologics vs. workplace-testing vs. reimbursement), because a fact learned on one side rarely transfers to the other.

8. Competitive dynamics and consolidation

Both children are consolidating, for opposite reasons.

• 621991 consolidates toward scale and vertical integration. Nonprofit blood centers merge because declining volume against high fixed costs makes independence unsustainable (recent deals fold regional centers into national networks). Plasma is a global oligopoly — CSL, Grifols, Takeda, Octapharma — competing on center footprint, donor yield, and manufacturing scale, where owning collection and fractionation is the winning structure. Organ procurement organizations resemble regulated regional franchises: competition means keeping your federal designation and hitting metrics, not winning customers.[3][10]
• 621999 consolidates a fragmented long tail. With an HHI of 167.8 nationally, this is a roll-up playground: strategic buyers rolled up cardiac monitoring; private equity is consolidating occupational health, drug-testing administration, case management, and screening. Scale helps via centralized scheduling, billing, credentialing, payer contracts, and software — but a low national HHI can still hide strong local concentration.[5][26][28]

Federal agencies (FTC, DOJ, HHS) have specifically scrutinized healthcare roll-ups and private-equity ownership, so the consolidation thesis on Side B carries policy risk.[29]

9. Risks

Shared across the level: high regulatory/compliance burden; reimbursement and hospital/payer pricing pressure; clinical-liability and safety/recall exposure; labor shortages (nurses, technicians, care managers); and the "residual bucket" measurement risk — because 62199 is a catch-all whose activity spills into manufacturing, labs, physician offices, and hospitals, it is hard to size or benchmark as an investment theme.

Concentrated on 621991: chronic blood-donor shortages; structural transfusion-volume decline against fixed costs (a solvency risk for small nonprofits); reliance on ethically contested paid plasma donation; IG demand/pricing cycles and company leverage (Grifols); and the multi-year federal overhaul of the organ-transplant system.[3][13][20]

Concentrated on 621999: CMS/CPT reimbursement cuts (the dominant risk for monitoring names like iRhythm); cannabis-driven erosion of drug testing; diagnosis-coding/False Claims Act exposure; customer/payer concentration; and debt-funded roll-up integration risk.[23][28][32]

Public-company mismatch (both sides): a stock can look like blood/organ or ambulatory-services exposure while most earnings come from unrelated pharmaceuticals, devices, or managed care — separate the relevant segment before valuing it.

10. How to invest, and the outlook

Public routes are always partial and side-specific.

• For 621991 exposure: direct plasma via CSL (ASX/OTC), Grifols (GRFS), Takeda (TAK), and closest-to-pure-play ADMA (ADMA); collection tools via Haemonetics (HAE); organ-preservation tech via TransMedics (TMDX) and XVIVO. Understand the plasma names as biologics manufacturers whose collection centers happen to fall in this code — the thesis is IG demand and manufacturing yield, not blood banking as such.[12][13][14][15][16][17][18]
• For 621999 exposure: focused names — iRhythm (IRTC) for remote cardiac monitoring (a reimbursement-sensitive med-tech growth stock) and CorVel (CRVL) for case management — plus occupational-health Concentra (CON) and small segments of Quest/Labcorp and the device majors.[23][24][25][26]

There is no ETF for this NAICS. The correct method on either side: identify the relevant segment or subsidiary, estimate what share of revenue truly resembles the code, track payer mix, reimbursement, volumes, and cash flow, and never apply a pure-play multiple to a diversified parent.

Private routes hold most of the industry. On Side A the accessible assets are for-profit plasma collection networks (prized by fractionators for supply security) and cord-blood storage; nonprofit blood centers and organ procurement organizations combine only through nonprofit mergers. On Side B — the more fertile ground, with an SBA "small-business" size standard of $20.5 million in receipts covering most operators [8] — the play is PE roll-ups and buy-and-build in occupational health, drug-testing administration, case management, and screening. Diligence on both sides centers on licensing, referral/coding practices, contracts, clinician retention, denial rates, and integration track record.

Outlook (editorial judgment). Two divergent trajectories under one label. On the blood/organ side the visible commercial growth is in vertically integrated plasma and organ-preservation technology, while the nonprofit transfusion core stays defensive but slow-declining and consolidating. On the miscellaneous side the structurally favored niches are remote cardiac monitoring and recurring-contract care management/occupational health, while drug testing stays flat-to-soft under cannabis liberalization. The overarching investor lesson from the rollup is the same one the concentration data show: 62199 is a drawer to mine niche-by-niche, on the correct side, not a market to buy wholesale. The main swing factors are donor supply and IG demand (Side A) and reimbursement rates and consolidation discipline (Side B).

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Sources

1. U.S. Census Bureau, 2022 Economic Census — Concentration of Largest Firms, NAICS 62199 (level receipts ~$45.296B; firms 7,638; CR4 20.5%, CR8 31.5%, CR20 44.9%, CR50 56.5%; HHI 161.4). https://data.census.gov/table/ECNSIZE2022.EC2200SIZECONCEN
2. U.S. Census Bureau, County Business Patterns 2023 — NAICS 62199 (establishments 11,637; employees 207,091; annual payroll ~$13.407B; Q1 payroll ~$3.397B). https://www.census.gov/programs-surveys/cbp.html
3. U.S. Census Bureau, 2022 NAICS — 6219 / 62199 structure and definitions (children 621991, 621999; sibling 621910 Ambulance Services; scope and exclusions). https://www.census.gov/naics/?input=62199&year=2022&details=62199
4. U.S. Census Bureau, 2022 Economic Census — Concentration of Largest Firms, NAICS 621991 (receipts ~$19.882B; firms 371; CR4 41.5%; HHI 573.6). https://data.census.gov/table/ECNSIZE2022.EC2200SIZECONCEN
5. U.S. Census Bureau, 2022 Economic Census — Concentration of Largest Firms, NAICS 621999 (receipts ~$25.413B; firms 7,270; CR4 21.4%; HHI 167.8). https://data.census.gov/table/ECNSIZE2022.EC2200SIZECONCEN
6. U.S. Census Bureau, County Business Patterns 2023 — NAICS 621991 (2,110 establishments; 90,025 employees; ~$5.279B annual payroll). https://www.census.gov/data/datasets/2023/econ/cbp/2023-cbp.html
7. U.S. Census Bureau, County Business Patterns 2023 — NAICS 621999 (9,527 establishments; 117,066 employees; ~$8.128B annual payroll). https://www.census.gov/programs-surveys/cbp.html
8. U.S. Small Business Administration, Table of Size Standards (NAICS 621991 = $40M; 621999 = $20.5M average annual receipts), 2023. https://www.sba.gov/document/support-table-size-standards
9. America's Blood Centers, About / America's Blood Supply (members ~60% of U.S. supply). https://americasblood.org/about/
10. P. Jaworski / Cornell SC Johnson, The Global Plasma Economy (U.S. ~70% of world source plasma; 1,200+ centers), 2025. https://business.cornell.edu/article/2025/05/the-global-plasma-economy/
11. ResearchAndMarkets / Businesswire, Plasma Derived Therapies Market — Insights & Forecast 2024–2028 (~$58B by 2028; IG growth), 2024. https://www.businesswire.com/news/home/20240613282301/en/
12. CSL Limited, FY2024 Results / Annual Report (group revenue ~US$14.8B; CSL Plasma 200+ U.S. centers), 2024–2025. https://investors.csl.com/annualreport/2025/
13. Grifols, S.A., Form 20-F for Fiscal Year 2024 (revenue ~€7.2B; leverage; diagnostics), 2025. https://www.sec.gov/Archives/edgar/data/1438569/000110465925034245/grfs-20241231x20f.htm
14. Takeda Pharmaceutical Co., Plasma-Derived Therapies / Form 20-F FY2024 (BioLife plasma centers), 2024–2026. https://www.takeda.com/science/areas-of-focus/pdt/
15. ADMA Biologics, Preliminary Full-Year 2024 Revenue (~$417–425M; plasma centers + IG manufacturing), Jan. 2025. https://ir.admabiologics.com/news-releases/news-release-details/adma-biologics-announces-preliminary-full-year-2024-revenue-and
16. Haemonetics Corporation, Annual Report FY2025, U.S. SEC, 2025. https://www.sec.gov/Archives/edgar/data/313143/000110465925000041/hae-20250605.htm
17. TransMedics Group, Fourth Quarter and Full Year 2025 Financial Results (Organ Care System), 2026. https://investors.transmedics.com/news-releases/news-release-details/transmedics-reports-fourth-quarter-and-full-year-2025-financial/
18. XVIVO Perfusion, Investor Relations, 2026. https://investor.xvivogroup.com/
19. Grand View Research, U.S. Cord Blood Banking Services Market (~$6.83B 2022; ~97% private), 2023. https://www.grandviewresearch.com/industry-analysis/us-cord-blood-banking-services-market
20. Association of Organ Procurement Organizations / organdonor.gov, OPO oversight; 56 U.S. OPOs; NOTA, 2024–2026. https://aopo.org/opo-oversight/
21. HRSA / UNOS, U.S. Surpassed 48,000 Organ Transplants in 2024, 2025. https://www.hrsa.gov/optn/news-events/news/organ-transplants-exceeded-48000-2024-33-percent-increase-transplants-performed-2023
22. U.S. Food and Drug Administration, Regulation of the Blood Supply; HCT/Ps (21 CFR 600–680, Part 1271), 2024–2026. https://www.fda.gov/vaccines-blood-biologics/blood-blood-products/regulation-blood-supply
23. iRhythm Technologies, Annual Report on Form 10-K and quarterly results (~$720–730M revenue 2025; long-term ECG reimbursement commentary), 2025/2026. https://www.sec.gov/Archives/edgar/data/1388658/000138865826000011/irtc-20251231.htm
24. CorVel Corporation, Annual Report on Form 10-K, 2025. https://www.sec.gov/Archives/edgar/data/874866/000095017025076999/crvl-20250331.htm
25. Concentra Group Holdings Parent, Annual Report on Form 10-K, 2025/2026. https://ir.concentra.com/sec-filings/all-sec-filings/content/0002014596-26-000029/cghp-20251231.htm
26. GlobeNewswire / Research and Markets, U.S. Employer and Workplace Drug Testing Market Report 2024 (Quest ~10M tests/year; Labcorp); Philips/BioTelemetry and Boston Scientific/Preventice acquisitions (2021). https://www.globenewswire.com/news-release/2024/10/15/2963369/28124/en/U-S-Employer-and-Workplace-Drug-Testing-Market-Report-2024.html
27. U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), Workplace Drug Testing; Mandatory Guidelines and DOT 49 CFR Part 40, 2025. https://www.samhsa.gov/substance-use/drug-free-workplace/drug-testing-resources
28. U.S. Department of Justice, Matrix, HealthFair, and Founder Agree to Pay $56.5M to Resolve False Claims Act Allegations (Medicare Advantage risk-adjustment coding from in-home assessments), 2026. https://www.justice.gov/opa/pr/matrix-healthfair-and-healthfair-founder-agree-pay-565m-resolve-false-claims-act-allegations
29. Federal Trade Commission / DOJ / HHS, Cross-Government Inquiry on Corporate Control (including private equity) in Health Care, 2024. https://www.ftc.gov/news-events/news/press-releases/2024/03/federal-trade-commission-department-justice-department-health-and-human-services-launch-cross-government
30. U.S. Department of Justice & Federal Trade Commission, 2023 Merger Guidelines, Guideline 1 (HHI thresholds), 2023. https://www.justice.gov/atr/merger-guidelines/applying-merger-guidelines/guideline-1
31. U.S. Department of Health and Human Services, ACBTSA Recommendations (blood-center margins), 2025. https://www.hhs.gov/oidp/advisory-committee/blood-tissue-safety-availability/acbtsa-recommendations/index.html
32. NORML / Jackson Lewis, State pre-employment marijuana testing restrictions, 2024. https://norml.org/blog/2024/01/02/washington-new-state-law-takes-effect-barring-pre-employment-marijuana-testing-for-most-employees/