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NPI 1194062448 · Marlborough, MA · Clinical Medical Laboratory
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Quest Diagnostics Massachusetts LLC is a clinical medical laboratory provider located in Marlborough, Massachusetts. This profile covers 524 Medicare and 478 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 Massachusetts LLC |
| Address | 200 Forest St |
| City | Marlborough |
| State | MA |
| ZIP | 01752 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | January 7, 2013 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $199.9M |
| Medicare | $27.8M |
QUEST DIAGNOSTICS MASSACHUSETTS LLC is a high-volume diagnostic laboratory by payer scale, reporting Total Medicare revenue of $27.8M and Total Medicaid revenue of $199.9M; Medicaid is the dominant payer by magnitude, making the provider effectively Medicaid-centered in overall billed volume. The NPI was enumerated 2013-01-07 (~13 years ago), indicating more than a decade of operation to build the large testing footprint reflected in the claims data.
Revenue concentration is notable on both payers: the top 3 Medicare codes account for 33.5% of this provider's total Medicare revenue, while the top 3 Medicaid codes account for 46.6% of its total Medicaid revenue. For Medicare the leading drivers include 36415 ($2.4M revenue, 12.7%), G0480 ($2.1M revenue, 11.4%), and 80061 ($1.8M revenue, 9.5%); for Medicaid the leading drivers are U0003 ($25.5M revenue, 18.4%), G0480 ($21.2M revenue, 15.3%), and 80307 ($17.9M revenue, 12.9%).
The code mix indicates a full‑service, high-throughput clinical laboratory operation: large-volume routine clinical chemistry and hematology panels (80061, 80053, 85025) coexist with extensive molecular infectious disease testing (U0003, 87491, 87591, 87636) and substantial forensic/toxicology work (G0480, 80307). This combination signals the lab handles both population-screening and high-complexity molecular assays, supporting outpatient and public-health testing workflows.
Competitive standing vs peers is consistently dominant for many codes. On Medicare several high-volume codes are labeled "extreme outlier" and rank at or near the top nationally (for example, 36415 ranks #21 of 86467 providers nationally and is described as an "extreme outlier", and G0480 ranks #3 of 1590 providers nationally as an "extreme outlier"). On Medicaid the provider routinely ranks #1–#3 in-state for major codes (U0003 #2 of 133 in-state at the 99th percentile and G0480 #2 of 202 in-state at the 100th percentile), indicating a dominant in-state market position for both COVID and drug-testing services.
Statistical outlier language in the source data reinforces exceptional volume: many codes are explicitly annotated as "extreme outlier" or at the 100th percentile, which for this entity appears across testing categories (hematology/chemistry, molecular infectious testing, and toxicology). Analysts should treat these labels as indicators of unusually high reporting relative to national or state peers, not as an assessment of appropriateness.
The provider shows concentrated specialization in both molecular infectious testing and drug testing on Medicaid: U0003 alone represents $25.5M (18.4% of Medicaid revenue) and G0480 represents $21.2M (15.3% of Medicaid revenue), while 80307 contributes $17.9M (12.9% of Medicaid revenue). This concentration suggests operational capacity optimized for high-volume SARS-CoV-2 PCR and definitive toxicology workflows that drive nearly half of Medicaid revenue through the top three codes.
On Medicare, routine specimen collection and basic panels are also revenue anchors: 36415 (blood collection) generated $2.4M (12.7% of Medicare revenue) and 80061 (lipid panel) generated $1.8M (9.5% of Medicare revenue), consistent with a durable referral base for outpatient lab draws and recurring chronic-care monitoring. The coexistence of high-volume, low-unit-value routine testing with higher-complexity assays (G0480, 81513) points to scale-based economics where throughput of many routine tests supports advanced testing services.
For payer strategy and network review, the data imply this facility is a major statewide lab partner for Medicaid-managed programs and also a nationally notable Medicare testing site for select CPT/HCPCS codes. Contracting, utilization management, and audit teams should prioritize high-impact codes called out here (U0003, G0480, 80307, 36415, 80061) because they account for large shares of revenue and are repeatedly annotated as outliers relative to peers.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
524 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 294,130 | $10 | $2.4M |
| 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… | 18,910 | $110 | $2.1M |
| 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. | 135,090 | $10 | $1.8M |
| 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. | 148,800 | $10 | $1.5M |
| 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… | 91,000 | $20 | $1.5M |
| 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… | 47,090 | $30 | $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… | 123,430 | $10 | $987.5K |
| 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. | 16,100 | $60 | $982.2K |
| 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).… | 72,870 | $10 | $728.7K |
| 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… | 62,880 | $10 | $503K |
Showing 1–10 of 524
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 524 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
524 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 83698 | 3 | 10 | 1,030 | $50 | $288.5K |
| 83876 | 3 | 10 | 360 | $50 | $243.6K |
| 81513 | 1 | 10 | 1,420 | $140 | $166.4K |
| 82725 | 2 | 10 | 8,430 | $20 | $155K |
| 83704 | 3 | 10 | 1,210 | $30 | $150.5K |
| 82542 | 3 | 10 | 1,670 | $20 | $126K |
| 87088 | 1 | 10 | 7,290 | $10 | $123.3K |
| 83921 | 2 | 10 | 1,280 | $20 | $122.5K |
| 86480 | 2 | 10 | 2,550 | $60 | $109.2K |
| 83695 | 3 | 10 | 2,440 | $10 | $107K |
Showing 1–10 of 524
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.
478 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… | 364,460 | $70 | $25.5M |
| 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… | 588,670 | $40 | $21.2M |
| 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. | 616,440 | $30 | $17.9M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 462,970 | $20 | $8.8M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 467,510 | $20 | $8.4M |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 87,520 | $50 | $4.6M |
| 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,… | 6,540 | $670 | $4.4M |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 90,710 | $40 | $3.7M |
| 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… | 261,450 | $10 | $3.7M |
| 81513 | The lab analyst performs the technical lab test on a vaginal fluid specimen for quantitative real–time amplification of RNA markers for three bacterial species listed in the code descriptor, and… | 69,030 | $50 | $3.5M |
Showing 1–10 of 478
How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts median
478 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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 | 20 | 310 | $260 | $2.1M |
| 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,… | 2 | 10 | 1,720 | $430 | $1.2M |
| 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… | 2 | 130 | 1,830 | $60 | $974.3K |
| 87633 | The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for… | 4 | 30 | 270 | $290 | $731.4K |
| 81329 | The lab analyst performs the technical lab test to detect deletions in the survival of motor neuron 1 (SMN1), telomeric, gene and may also analyze the survival of motor neuron 2 (SMN2), centromeric,… | 2 | 10 | 1,210 | $50 | $714K |
| 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. | 3 | 370 | 500 | $40 | $605.1K |
| 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… | 2 | 200 | 450 | $30 | $511.5K |
| 81513 | The lab analyst performs the technical lab test on a vaginal fluid specimen for quantitative real–time amplification of RNA markers for three bacterial species listed in the code descriptor, and… | 2 | 30 | 520 | $70 | $468.5K |
| 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… | 9 | 20 | 440 | $100 | $385.6K |
| 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)… | 31 | 100 | 290 | $120 | $356.6K |
Showing 1–10 of 478
Other providers in the same ZIP code as Quest Diagnostics Massachusetts LLC, ranked by combined Medicare and Medicaid revenue.
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