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NPI 1134277494 · Elmwood Park, NJ · Clinical Medical Laboratory
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Bioreference Health, LLC is a clinical medical laboratory provider located in Elmwood Park, New Jersey. This profile covers 579 Medicare and 626 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 | Bioreference Health, LLC |
| Address | 481 Edward H Ross Dr |
| City | Elmwood Park |
| State | NJ |
| ZIP | 07407 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | January 5, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $620.1M |
| Medicare | $66.8M |
BIOREFERENCE HEALTH, LLC reports substantially larger lifetime Medicaid activity than Medicare, with Total Medicare revenue of $66.8M versus Total Medicaid revenue of $620.1M; the Medicaid book of business is an order of magnitude larger, indicating the provider operates primarily as a high-volume Medicaid laboratory rather than a Medicare-focused practice. This scale difference implies payer mix and contracting considerations will be dominated by Medicaid reimbursement and volume dynamics.
The provider has a long-established enrollment history (NPI enumerated 2007-01-05 (~19 years ago)), supporting an operational footprint and processes consistent with large centralized laboratory operations that handle sustained, high-volume test throughput across multiple payers. Tenure of this length is consistent with substantial investments in instrumentation and logistics that underpin the high claim counts shown in both Medicare and Medicaid data.
Medicare revenue is concentrated in a small set of specialized diagnostic services: 81539 ($10M), 81450 ($3.6M), and 88185 ($3.5M) together account for the Precomputed top-3 share of 44.1% of this provider's total Medicare revenue. Those codes represent predictive prostate cancer assays, multigene hematolymphoid panels, and high-volume flow cytometry add-on markers, which together indicate a significant capability in advanced molecular and hematopathology testing alongside routine lab services.
On the Medicaid side the top Medicare-style concentration pattern is different but still pronounced: U0003 ($47.9M), 87491 ($33.7M), and 87591 ($32.8M) are the top three Medicaid revenue drivers and together account for the Precomputed top-3 share of 31.6% of this provider's total Medicaid revenue. These codes — high-throughput SARS-CoV-2 PCR and amplified NAAT tests for Chlamydia and Gonorrhea — point to a large infectious-disease screening and public-health testing operation that processes massive specimen volumes.
Revenue and service-line breadth show both concentration and diversification: while the precomputed top-3 shares signal meaningful revenue dependence on a few high-yield codes (44.1% Medicare, 31.6% Medicaid), the provider also reports very large claim volumes across routine panels and analytes such as 80053 (262.1K Medicare claims; 2.8M Medicaid claims), 82306 (73.1K Medicare claims; 1.5M Medicaid claims), and 84443 (113.9K Medicare claims; 1.7M Medicaid claims), reflecting a mixed business model combining high-value molecular testing with high-throughput clinical chemistry and immunoassays.
Against national Medicare peers BIOREFERENCE is a market leader on multiple specialized codes: 81539 ranks #1 of 4 nationally (100th percentile; typical), 81450 ranks #1 of 48 (100th percentile; extreme outlier), and 88185 ranks #1 of 618 (100th percentile; extreme outlier). Those rank and percentile positions characterize the provider as a dominant national player for several advanced molecular and flow-cytometry services, rather than a modest regional participant.
In-state competitive positioning for Medicaid also shows dominance on many high-volume tests: U0003 ranks #4 of 127 in-state (98th percentile; notably above typical), 87491 and 87591 both rank #2 in-state (99th percentile; extreme outliers), 86769 ranks #1 of 61 (100th percentile; extreme outlier), and 87799 ranks #1 of 25 (100th percentile; extreme outlier). These standing and percentile labels indicate BIOREFERENCE is a major, often top-ranked laboratory in New Jersey for infectious-disease and molecular assay volumes, suggesting strong Medicaid contracting and specimen sourcing within the state.
Operationally, the combination of massive Medicaid claim counts (for example 87491 1.9M claims, 87591 1.9M claims, 80053 2.8M claims) and concentrated high-revenue Medicare specialty testing implies a central laboratory model with both high-throughput screening pipelines and specialized molecular/hematopathology workflows. For payers and network planners, this profile signals a single vendor capable of scaling public-health and routine diagnostic volume while also providing specialized genomic and flow cytometry services that generate disproportionate Medicare 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.
579 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81539 | The lab analyst performs the technical lab steps to evaluate blood for total prostate specific antigen (PSA), free PSA, intact PSA, and human kallikrein–2 (hK2), and performs a predictive algorithm… | 13,500 | $740 | $10M |
| 81450 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen, such as blood or bone marrow, for DNA and possibly RNA alterations in five to 50 genes known to impact… | 4,860 | $740 | $3.6M |
| 88185 | The lab analyst performs the technical component of a flow cytometry procedure using cell surface, cytoplasmic, or nuclear markers to characterize cells and aid clinicians in diagnosing patients with… | 160,510 | $20 | $3.5M |
| 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. | 262,050 | $10 | $2.6M |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 73,060 | $30 | $2.1M |
| 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… | 113,890 | $20 | $1.8M |
| 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. | 121,970 | $10 | $1.6M |
| 88374 | The lab analyst applies a single multiplex in situ hybridization probe stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. The lab analyst processes the slides… | 7,530 | $190 | $1.4M |
| 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… | 165,610 | $10 | $1.3M |
| 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).… | 99,750 | $10 | $997.5K |
Showing 1–10 of 579
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 579 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
579 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81539 | 1 | 10 | 13,500 | $740 | $10M |
| 81455 | 4 | 10 | 530 | $2,850 | $1.9M |
| 81450 | 1 | 10 | 230 | $740 | $833.5K |
| G0145 | 3 | 10 | 11,530 | $30 | $288.2K |
| 87798 | 8 | 40 | 1,760 | $30 | $284.3K |
| 88120 | 13 | 20 | 200 | $350 | $278K |
| 81162 | 5 | 10 | 80 | $1,790 | $271.4K |
| 88185 | 1 | 20 | 690 | $20 | $265.7K |
| 87536 | 3 | 10 | 2,150 | $80 | $207K |
| 88377 | 4 | 20 | 30 | $240 | $205.5K |
Showing 1–10 of 579
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.
626 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | 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… | 675,270 | $70 | $47.9M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 1,871,550 | $20 | $33.7M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 1,930,170 | $20 | $32.8M |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 1,451,730 | $20 | $24.7M |
| 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. | 2,774,570 | $10 | $16.6M |
| 86769 | The lab analyst performs a multiple–step immunoassay to evaluate the patient’s serum for antibodies to severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), which causes coronavirus disease… | 414,940 | $40 | $14.9M |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 766,640 | $20 | $14.6M |
| 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… | 406,840 | $40 | $14.2M |
| 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… | 1,160,900 | $10 | $13.9M |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 400,060 | $30 | $13.6M |
Showing 1–10 of 626
How this provider's Medicaid billing volume and revenue compare to other New Jersey providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Jersey median
626 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81507 | The lab analyst performs the technical lab tests to detect fetal trisomies 13, 18 and 21 in the maternal plasma during pregnancy. The analyst uses a micro assay technique and carries out an… | 1 | 10 | 23,310 | $260 | $6.2M |
| 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… | 4 | 130 | 3,180 | $60 | $4.2M |
| 81420 | The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,… | 3 | 10 | 5,420 | $280 | $4.1M |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 3 | 40 | 590 | $20 | $1.9M |
| 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. | 4 | 150 | 3,680 | $30 | $1.5M |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 3 | 40 | 810 | $30 | $1.4M |
| 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… | 2 | 20 | 750 | $10 | $1.3M |
| 81220 | The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR… | 2 | 30 | 210 | $200 | $1.3M |
| 80081 | The lab analyst performs an obstetric panel; this panel must include tests for a complete blood count with differential, a hepatitis B surface antigen test, a single–result test for HIV–1 antigens… | 3 | 10 | 51,370 | $40 | $1.3M |
| 81539 | The lab analyst performs the technical lab steps to evaluate blood for total prostate specific antigen (PSA), free PSA, intact PSA, and human kallikrein–2 (hK2), and performs a predictive algorithm… | 1 | 10 | 7,960 | $140 | $1.1M |
Showing 1–10 of 626
Other providers in the same ZIP code as Bioreference Health, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Atmiya Adult Day Care LLC | NJ | Adult Day Care Clinic/Center | $0 | $19.9M |
| Careway Medical Adult Day Care Corp | NJ | Adult Day Care Clinic/Center | $0 | $16.9M |
| River Drive Surgery Center, LLC | NJ | Ambulatory Surgical Clinic/Center | $8M | $8.8M |
| Garden State Rehab Services | NJ | Rehabilitation Clinic/Center | $0 | $12.3M |
| Preferred Home Health Care & Nursing Services, Inc. | NJ | Home Health Agency | $0 | $11.5M |
| Biogenica Laboratories LLC | NJ | Clinical Medical Laboratory | $149K | $2.3M |
| Masters Ambulance Service | NJ | Non-emergency Medical Transport (VAN) | $801K | $382.8K |
| Global Health Ems Inc | NJ | Land Ambulance | $570.3K | $317K |
| Pinnacle Mri Group, LLC | NJ | Radiology Clinic/Center | $8.5K | $813.6K |
| Hadley Phillips | NJ | Ophthalmology Physician | $382.2K | $0 |
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