Loading...
NPI 1104016088 · Maryland Heights, MO · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Quest Diagnostics Clinical Laboratories Inc is a clinical medical laboratory provider located in Maryland Heights, Missouri. This profile covers 101 Medicare and 95 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 | Quest Diagnostics Clinical Laboratories Inc |
| Address | 11636 Administration Drive |
| City | Maryland Heights |
| State | MO |
| ZIP | 63146 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | July 27, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.1M |
| Medicaid | $3M |
This entity reports very similar scale across the two public payers with Total Medicare revenue: $3.1M and Total Medicaid revenue: $3M, indicating it is not effectively single‑payer but instead operates at comparable size for both programs. The NPI is long‑standing (NPI enumerated (registered): 2007-07-27 (~19 years ago)), consistent with an established laboratory footprint rather than a new entrant.
The mix of high‑volume CPTs—including routine panels and phlebotomy codes such as 80053, 80061, 83036, 85025 and 36415—indicates the operation functions as a high‑throughput clinical diagnostic laboratory focused on outpatient screening and monitoring (metabolic panels, lipid panels, A1C monitoring, CBCs and specimen collection). Medicaid volumes additionally show very large cytology and microbiology throughput (88175, 87086, 87088), demonstrating a service line that couples routine chemistry/hematology with significant cytology and microbiology processing.
Revenue concentration is meaningful on both payers: the top 3 Medicare codes account for 40.1% of Total Medicare revenue and are driven by 80053 (16.4%), 80061 (12.9%), and 83036 (10.8%), showing routine panels and A1C testing are the largest Medicare revenue drivers. On the Medicaid side the top 3 codes account for 43.1% of Total Medicaid revenue, dominated by 88175 (24.6%), 87086 (10.9%), and 87088 (7.5%), which centers Medicaid revenue on cytology and urine microbiology services.
National competitive standing on Medicare is consistently high: multiple top CPTs rank at the 99th–100th percentile nationally (for example 80053 ranks #71 of 26416, 80061 #73 of 21671, 83036 #59 of 44997 and 85025 #83 of 32833), so this provider operates at unusually large volume for common lab panels relative to national peers. These percentile and rank positions support characterizing the provider as a major national volume contributor for routine outpatient lab testing rather than a modest or marginal participant.
State competitive standing on Medicaid is concentrated and dominant in several areas: the provider ranks #1 in‑state for multiple high‑revenue Medicaid codes (88175, 87086, 87088, 88141 and 88142 are all listed at rank #1 in‑state where reported), placing it as a leading cytology and urine microbiology processor within Missouri. Several other Medicaid codes (e.g., 80061 rank #2 in‑state, 87186 rank #2 in‑state) further underline a commanding in‑state position for both molecular/cytology and microbiology testing.
Specific tests are flagged as statistical outliers or notably above typical volume, which highlights where capacity and utilization deviate from peers: on Medicare 83036 is described as an "extreme outlier, far above typical national volume" and 85610 is an "extreme outlier," while on Medicaid 88175, 87086 and 87088 are each labeled "extreme outlier" or "far above typical state volume." These labels signal exceptionally high throughput in diabetes monitoring, coagulation testing, cervical cytology and urine microbiology respectively, consistent with centralized processing or service contracts.
The profile shows a balanced but concentrated operational footprint: routine screening/monitoring codes drive Medicare revenue while cytology and microbiology dominate Medicaid revenue. For payers and network managers this suggests two focal areas for vendor engagement—high‑volume outpatient chemistry/hematology for Medicare claims and concentrated cytology/microbiology processing for Medicaid—rather than a diffuse mix of specialty testing.
Given the combination of long tenure (NPI enumerated (registered): 2007-07-27 (~19 years ago)), national high‑volume rankings for common panels and state dominance in Medicaid cytology/microbiology, this provider should be considered a tier‑level laboratory partner with substantial processing capacity; payers may prioritize contract terms, quality of processing (e.g., turnaround time and interpretive services for 88175/88141), and utilization management around the few codes that concentrate the majority of revenue.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
101 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 46,800 | $10 | $468K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 28,290 | $10 | $367.8K |
| 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).… | 30,890 | $10 | $308.9K |
| 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… | 36,220 | $10 | $289.8K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 29,190 | $10 | $233.5K |
| 87086 | Culture, bacterial; quantitative, colony count, urine. | 23,300 | $10 | $186.4K |
| 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… | 8,820 | $20 | $141K |
| G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under… | 5,340 | $30 | $138.9K |
| 87088 | The lab analyst or microbiologist observes a urine culture with an unknown organism or organisms and makes a presumptive identification of each organism that needs identification. | 16,490 | $10 | $131.9K |
| 87077 | The lab analyst performs additional tests on a presumptively identified aerobic isolate to definitively, which means more specifically, identify the organism, such as to the level of species. | 12,010 | $10 | $96.1K |
Showing 1–10 of 101
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 101 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
101 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87449 | 1 | 10 | 3,880 | $10 | $45.5K |
| G0145 | 1 | 10 | 20 | $30 | $21.5K |
| 87329 | 1 | 10 | 1,550 | $10 | $18.2K |
| 87086 | 1 | 10 | 130 | $10 | $17K |
| 87427 | 1 | 10 | 1,340 | $10 | $15.8K |
| 87328 | 1 | 10 | 1,140 | $10 | $15.5K |
| 87186 | 1 | 10 | 180 | $10 | $14.3K |
| 87088 | 1 | 10 | 60 | $10 | $13.4K |
| 87077 | 1 | 10 | 60 | $10 | $12.7K |
| 87045 | 1 | 10 | 1,350 | $10 | $12.4K |
Showing 1–10 of 101
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.
95 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 88175 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 37,570 | $20 | $676.2K |
| 87086 | Culture, bacterial; quantitative, colony count, urine. | 37,510 | $10 | $300.1K |
| 87088 | The lab analyst or microbiologist observes a urine culture with an unknown organism or organisms and makes a presumptive identification of each organism that needs identification. | 22,850 | $10 | $205.6K |
| 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. | 18,280 | $10 | $146.3K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 14,340 | $10 | $129.1K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 3,400 | $40 | $119K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 3,380 | $40 | $118.4K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 2,810 | $40 | $118.2K |
| 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… | 2,850 | $40 | $113.9K |
| 87186 | The lab analyst performs the technical steps to evaluate a culture isolate’s susceptibility, or sensitivity, to multiple antimicrobial agents, commonly called antibiotics, by observing growth of the… | 11,080 | $10 | $99.7K |
Showing 1–10 of 95
How this provider's Medicaid billing volume and revenue compare to other Missouri providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Missouri median
95 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 38 | 240 | 1,740 | $40 | $353.4K |
| 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… | 43 | 320 | 980 | $40 | $352.7K |
| 81001 | Urinalysis is used to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is used to detect urinary tract infections (UTI) and other… | 29 | 160 | 720 | $60 | $218.3K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 28 | 130 | 450 | $60 | $158.5K |
| 80076 | The lab analyst performs a hepatic function panel test in which he measures the blood levels of total protein, albumin, alkaline phosphatase, bilirubin, both total and direct, and liver enzymes. | 34 | 40 | 70 | $70 | $144.3K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 10 | 120 | 260 | $50 | $136.3K |
| 85027 | The lab analyst performs a blood count on the red and white blood cells and platelets also known as thrombocytes. He also determines the hemoglobin, typically by spectrophotometry, and the… | 12 | 120 | 130 | $60 | $103K |
| 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… | 29 | 200 | 220 | $60 | $94.1K |
| 83690 | The lab analyst measures the amount of lipase enzyme in the patient specimen. Lipase is an enzyme that the pancreas secretes to help in the absorption of fat. | 85 | 100 | 490 | $40 | $89.1K |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 11 | 50 | 130 | $60 | $82.7K |
Showing 1–10 of 95
Other providers in the same ZIP code as Quest Diagnostics Clinical Laboratories Inc, ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.