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NPI 1104255215 · Newport, KY · Clinical Medical Laboratory
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Ethos Holding Corp is a clinical medical laboratory provider located in Newport, Kentucky. This profile covers 53 Medicare and 127 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 | Ethos Holding Corp |
| Address | 29 E 6th St |
| City | Newport |
| State | KY |
| ZIP | 41071 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | November 8, 2013 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $28.5M |
| Medicare | $17.8M |
Payer mix and scale: ETHOS HOLDING CORP reports Total Medicare revenue: $17.8M and Total Medicaid revenue: $28.5M, making Medicaid the larger payer relationship by dollars on file. This is not a single-payer operation — the practice generates material revenue from both Medicare and Medicaid, with Medicaid representing the larger share of lifetime revenue.
Service line profile: the provider’s billed codes indicate a clinical laboratory operation focused on high-volume SARS‑CoV‑2 testing and broad-spectrum drug testing, plus a proprietary PLA. High-revenue COVID-related codes (U0004, U0005, G2023) and definitive drug panels (G0482, G0483, G0481, G0480) dominate the claims mix, and the presence of PLA code 0117U indicates the lab performs at least one proprietary, algorithm-driven metabolic/pain index test.
Medicare revenue concentration: ETHOS’s top three Medicare codes account for 73.5% of its Medicare revenue, driven by K1034 ($6M, 33.6% of Medicare revenue), 0117U ($4.7M, 25.9%), and G0482 ($2.5M, 13.9%). These three lines together show the business is highly concentrated in a few tests rather than a broad distributed mix of low-revenue codes.
Medicaid revenue concentration: the top three Medicaid codes account for 59.3% of Medicaid revenue, principally U0004 ($8.1M, 29.4%), G0483 ($5.5M, 19.8%), and 80307 ($2.8M, 10.1%). This concentration highlights Medicaid-facing volume drivers that are predominantly COVID diagnostic testing and both definitive and presumptive drug testing services.
Competitive standing — Medicare: ETHOS appears as a major national outlier on several Medicare tests: K1034 is an "extreme outlier, far above typical national volume for this code" (rank #80 of 30143, 100th percentile), G0482 is an "extreme outlier, far above typical national volume for this code" (rank #5 of 1618, 100th percentile), and multiple drug-testing panels (G0480/G0481/80307) also sit at very high national percentiles. The proprietary PLA 0117U shows rank #1 of 1 providers nationally with "no national peer volume comparison available," signaling a unique product line with substantial Medicare revenue.
Competitive standing — Medicaid/in-state dominance: on Medicaid ETHOS is a dominant in-state player for COVID and many specialized assays — U0004 is rank #1 of 33 in-state and labeled an "extreme outlier, far above typical state volume for this code," and G2023 is rank #1 of 107 in-state (100th percentile; extreme outlier). Several metabolic and mass‑spec codes (83921, 83789, 82542, 84207, 83090) are rank #1 in-state or near the top, reinforcing that ETHOS commands unusually large in-state volumes across multiple specialized lab services.
COVID testing contrast by payer: COVID testing volume is heavily skewed toward Medicaid — U0004 shows 142.6K claims and $8.1M revenue in Medicaid (rank #1 in-state, extreme outlier) versus only 2.1K claims and $156.6K revenue in Medicare (rank #37 nationally, 86th percentile; typical, unremarkable volume for this code). This indicates ETHOS’s COVID testing infrastructure has been deployed at much larger scale for Medicaid clients or settings compared with its Medicare footprint.
Proprietary test and payer pricing divergence: the PLA code 0117U contributes $4.7M to Medicare revenue with 5.6K claims and an average Medicare payment of $824 avg paid/claim, while Medicaid shows 18.3K claims and $642K revenue with $35 avg paid/claim for the same code. That pattern (high Medicare paid/claim, much larger Medicaid claim count but lower Medicaid revenue) highlights both a proprietary diagnostic offering and substantial payer-specific price and revenue differences that will matter for contract and utilization review.
Tenure and operational implications: the NPI enumerated (registered) on 2013-11-08 (~13 years ago), indicating an established presence in the market. Combined with sustained high-ranked volumes on multiple codes, the tenure supports a conclusion that ETHOS has had time to scale laboratory capacity and procurement to support the high claim volumes reported, especially on Medicaid.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
53 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 502,490 | $10 | $6M |
| 0117U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0117U for the… | 5,650 | $820 | $4.7M |
| G0482 | 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… | 12,820 | $200 | $2.5M |
| G0483 | 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… | 6,220 | $240 | $1.5M |
| 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. | 17,500 | $60 | $1.1M |
| 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… | 8,010 | $110 | $897.1K |
| G0481 | 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… | 5,500 | $150 | $840.7K |
| 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… | 2,120 | $70 | $156.6K |
| 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,… | 2,110 | $30 | $52.8K |
| 83789 | The lab analyst performs the technical lab test to evaluate the specimen for the presence or amount of a nondrug analyte by using mass spectrometry and tandem mass spectrometry. | 1,390 | $20 | $33.4K |
Showing 1–10 of 53
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 53 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
53 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 0117U | 1 | 10 | 5,650 | $820 | $4.7M |
| G0483 | 1 | 40 | 80 | $240 | $97.8K |
| G0482 | 1 | 40 | 60 | $190 | $97.3K |
| U0004 | 1 | 10 | 140 | $70 | $44.4K |
| G0481 | 1 | 80 | 130 | $150 | $37.8K |
| 83789 | 1 | 10 | 1,390 | $20 | $32.9K |
| G0480 | 1 | 130 | 60 | $110 | $25.4K |
| K1034 | 1 | 330 | 340 | $10 | $23.1K |
| 80307 | 1 | 230 | 150 | $60 | $20.4K |
| 81225 | 1 | 10 | 60 | $290 | $17.4K |
Showing 1–10 of 53
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.
127 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… | 142,590 | $60 | $8.1M |
| G0483 | 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… | 86,770 | $60 | $5.5M |
| 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. | 138,970 | $20 | $2.8M |
| G0482 | 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… | 62,400 | $40 | $2.2M |
| 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,… | 118,980 | $20 | $2M |
| G0481 | 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… | 36,170 | $50 | $1.6M |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 100,420 | $10 | $1.3M |
| 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… | 32,600 | $20 | $782.4K |
| 0117U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0117U for the… | 18,340 | $40 | $642K |
| 83921 | The lab analyst measures the single organic acid analyte ordered, which may be any one of the more than 60 identified organic acid analytes. The specimen type may be serum, plasma, urine, amniotic… | 30,040 | $10 | $420.5K |
Showing 1–10 of 127
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
127 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G0483 | 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… | 6 | 70 | 1,650 | $100 | $2M |
| G0482 | 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… | 4 | 50 | 2,830 | $90 | $1.4M |
| G0481 | 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… | 7 | 80 | 990 | $60 | $912.2K |
| 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. | 7 | 340 | 2,700 | $40 | $673.3K |
| 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 | 30 | 2,090 | $50 | $662.1K |
| 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… | 12 | 140 | 2,000 | $60 | $639.8K |
| 0117U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0117U for the… | 1 | 10 | 18,340 | $30 | $638.4K |
| 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… | 40 | 70 | 310 | $100 | $495.2K |
| 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. | 149 | 200 | 16,730 | $10 | $365.9K |
| 83918 | The lab analyst measures the total organic acids, with a 24 hour urine being the preferred specimen. Organic acids are a byproduct of metabolism and derive from many sources, such as, fatty acids,… | 1 | 10 | 29,820 | $10 | $234.3K |
Showing 1–10 of 127
Other providers in the same ZIP code as Ethos Holding Corp, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Healthpoint Family Care Inc | KY | Federally Qualified Health Center (FQHC) | $0 | $29.1M |
| Michael Wehmann | KY | Ophthalmology Physician | $171.2K | $0 |
| Robert Toltzis | KY | Cardiovascular Disease Physician | $138.9K | $0 |
| Darek Sanford | KY | Cardiovascular Disease Physician | $116.2K | $0 |
| Elizabeth Czirr | KY | Optometrist | $51.1K | $8.9K |
| Richard Abrahamson | KY | Ophthalmology Physician | $52K | $0 |
| Michelle Garrison | KY | Physician Assistant | $33.1K | $0 |
| Elaine Shields | KY | Registered Nurse | $32.8K | $0 |
| Kristin Legrand | KY | Nurse Practitioner | $22.4K | $0 |
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