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NPI 1043858996 · Lexington, SC · Pharmacy
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M Holdings LLC is a pharmacy provider located in Lexington, South Carolina. This profile covers 19 Medicare and 11 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 | M Holdings LLC |
| Address | 808 Highway 378 Ste A |
| City | Lexington |
| State | SC |
| ZIP | 29072 |
| Taxonomy | Pharmacy |
| NPI Enumerated | December 11, 2019 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.5M |
| Medicaid | $355.1K |
This provider is heavily Medicare-weighted: lifetime Medicare revenue is $2.5M versus Medicaid revenue of $355.1K, so Medicare accounts for the large majority of billed revenue and is the primary commercial channel for this entity’s services. Medicaid activity exists but is an order of magnitude smaller in scale.
Medicare revenue is concentrated in a few high-value codes: the precomputed top three Medicare codes account for 54.4% of total Medicare revenue, driven by 0241U ($750.7K, 29.6%), 91322 ($375.7K, 14.8%), and K1034 ($253K, 10.0%). This concentration indicates the business is materially dependent on a small set of vaccine- and COVID-test–related codes for most of its Medicare receipts.
The code mix and volumes point to a pharmacy operation that focuses on COVID-19 testing and vaccination services: high counts for K1034 (21.1K claims) show large-scale distribution/processing of nonprescription self-tests, while vaccine administration codes such as 91322, 91320, 90694 and in-home administration M0201 (4.3K claims, $146.4K) indicate active vaccination services and at-home delivery. Specimen-collection and lab-test codes like G2023 (5K claims, $114.7K) and multiple immunoassay and nucleic acid codes further confirm substantial testing throughput.
The provider is a strong national outlier on several Medicare codes: 0241U ranks #2 of 2910 providers (100th percentile) and is labeled an "extreme outlier," M0201 ranks #1 of 375 providers (100th percentile, extreme outlier), and 90694 ranks #12 of 51679 providers (100th percentile, extreme outlier). Multiple other top Medicare codes are at the 100th percentile or described as "notably above typical national volume," indicating a dominant position nationally for select vaccine and testing services.
By contrast, the provider’s Medicaid footprint is more concentrated in a few testing codes and is not broadly dominant in-state: Medicaid top three codes account for 70.9% of Medicaid revenue, led by U0004 ($146.9K, 41.4%), 87811 ($58.1K, 16.4%), and 87804 ($46.5K, 13.1%). U0004 ranks #8 of 17 in-state (56th percentile) and is described as "typical, unremarkable volume," so the provider appears to be a modest participant in South Carolina Medicaid testing markets rather than a statewide leader.
Medicaid competitive signals are mixed across specific codes: some testing codes (87811, 87804, G2023) show meaningful claim volumes but generally fall in mid-to-upper percentiles in-state (for example 87811 at 74th percentile), while other codes such as 0241U have low in-state rank (24.8K claims nationally but rank #48 of 54 in-state, 11th percentile). Overall, Medicaid activity appears focused on lab testing reimbursement rather than the high-volume vaccination and in-home administration that drive Medicare revenue.
The provider’s operational profile creates concentration risk and strategic sensitivity to changes in testing and vaccination demand: with Medicare top-three codes accounting for 54.4% of Medicare revenue and Medicaid top-three codes accounting for 70.9% of Medicaid revenue, shifts in reimbursement, public-health testing needs, or vaccine uptake for a small number of codes could materially affect revenue. Analysts should monitor utilization of 0241U, K1034, U0004, and the major vaccine administration codes as bellwethers.
The NPI was enumerated on 2019-12-11 (~7 years ago), indicating a relatively recent enrollment horizon; within that timeframe the provider scaled to high volumes on several pandemic-era codes. This tenure, combined with extreme outlier status on multiple Medicare codes, suggests a rapid operational ramp focused on COVID-era testing and vaccination services rather than a long-standing, broad-spectrum pharmacy billing profile.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
19 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0241U | N/A | 5,360 | $140 | $750.7K |
| 91322 | This code represents a SARS–CoV–2 vaccine product administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 50 mcg/0.5 mL. | 2,630 | $140 | $375.7K |
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 21,080 | $10 | $253K |
| 90694 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is an inactivated, adjuvanted, preservative–free vaccine given as a 0.5 mL… | 2,360 | $80 | $179.4K |
| 91320 | This code represents a SARS–CoV–2 vaccine product (tris–sucrose formulation) administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 30 mcg/0.3 mL. | 1,310 | $130 | $167.9K |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 3,850 | $40 | $150K |
| M0201 | Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s)… | 4,310 | $30 | $146.4K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 4,990 | $20 | $114.7K |
| 87811 | The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by… | 2,330 | $40 | $95.5K |
| 90677 | This code represents a vaccine product administered intramuscularly to protect against pneumococcal disease, a bacterial infection. This is a 20–valent vaccine, protecting against 20 strains of the… | 270 | $280 | $76.1K |
Showing 1–10 of 19
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 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.
11 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by… | 1,190 | $120 | $146.9K |
| 87811 | The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by… | 810 | $70 | $58.1K |
| 87804 | The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings. | 860 | $50 | $46.5K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 1,540 | $30 | $43.2K |
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 200 | $140 | $28.3K |
| 0241U | N/A | 80 | $230 | $18.8K |
| 87428 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2… | 90 | $60 | $5.4K |
| 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,… | 130 | $30 | $4K |
| 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)… | 20 | $150 | $2.4K |
| 0012A | N/A | 20 | $40 | $670 |
Showing 1–10 of 11
How this provider's Medicaid billing volume and revenue compare to other South Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Carolina median
11 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 48 | 70 | 600 | $130 | $307.2K |
| 0241U | N/A | 48 | 50 | 1,840 | $90 | $291.4K |
| 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)… | 59 | 60 | 540 | $110 | $271.5K |
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by… | 8 | 20 | 990 | $80 | $159.1K |
| 87428 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2… | 103 | 140 | 270 | $60 | $89.1K |
| 87811 | The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by… | 30 | 110 | 290 | $40 | $84.4K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 26 | 70 | 370 | $30 | $52.1K |
| 87804 | The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings. | 207 | 540 | 350 | $20 | $52K |
| 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,… | 44 | 60 | 390 | $10 | $28.8K |
| 0012A | N/A | 38 | 60 | 50 | $40 | $2.9K |
Showing 1–10 of 11
Other providers in the same ZIP code as M Holdings LLC, ranked by combined Medicare and Medicaid revenue.
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