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NPI 1194769497 · Austin, TX · Clinical Medical Laboratory
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Clinical Pathology Laboratories, Inc. is a clinical medical laboratory provider located in Austin, Texas. This profile covers 550 Medicare and 496 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 | Clinical Pathology Laboratories, Inc. |
| Address | 9200 Wall St |
| City | Austin |
| State | TX |
| ZIP | 78754 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | June 16, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $159.4M |
| Medicare | $47.7M |
CLINICAL PATHOLOGY LABORATORIES, INC. is a high‑volume clinical laboratory focused on routine chemistry, hematology and immunoassay testing: its Medicare top revenue codes include 80053 (CMP, $4.4M), 80061 (lipid panel, $3.9M) and 84443 (TSH, $3.9M), and its Medicaid mix includes very large volumes for broad panels such as 80050 (general health panel, $10.1M) and 80081 (obstetric panel, $4.4M). The code mix (multiple panel and single‑analyte chemistry codes, plus high volumes of specimen collection 36415 and CBC 85025) indicates an operation built around high-throughput diagnostic testing and specimen processing rather than episodic specialty procedures.
Revenue concentration is material but not extreme: the top 3 Medicare codes by revenue account for 34.7% of this provider’s Medicare revenue and the top 3 Medicaid codes account for 32.5% of Medicaid revenue. For payers and risk teams, this means a sizable share of payments are driven by a small set of high-frequency lab panels and infectious disease/STD assays, concentrating payment exposure in a few test categories.
Payer mix is Medicaid‑heavy: the provider reports $47.7M in total Medicare revenue versus $159.4M in total Medicaid revenue, indicating Medicaid is the dominant payer by scale for this NPI. Analysts should treat this entity as effectively Medicaid‑centric when assessing market impact and contracting leverage in Texas.
The provider is a dominant competitor on both national Medicare and Texas Medicaid leaderboards for many standard lab codes: for Medicare, codes such as 80053, 80061, 84443, 36415 and 85025 all rank in the top ~10–15 nationally and are flagged as "extreme outlier, far above typical national volume for this code"; for Medicaid, U0003, 80050, 87491, 87591 and multiple other codes rank #1–#4 in‑state and are similarly labeled as extreme outliers. These rank/percentile signals identify the lab as a major processing hub with outsized volume relative to peers.
COVID and infectious disease testing are a material component of Medicaid revenue: U0003 alone generated $17.9M (15.7% of Medicaid revenue) and U0005 contributed $3.5M, both with high in‑state ranks (U0003 ranks #4 in‑state, 99th percentile). Combined with large Medicaid volumes for Chlamydia 87491 ($9.1M) and Gonorrhea 87591 ($8.9M), the data point to significant capacity for high-throughput NAAT testing and public health screening.
Definitive and presumptive drug testing are meaningful revenue streams across payers: G0480 and 80307 appear in the top lists for both Medicare and Medicaid (Medicare G0480 $522.7K, 98th percentile; Medicare 80307 $550.2K, 99th percentile; Medicaid 80307 $7.3M, rank #2 in‑state). These entries indicate the lab operates advanced toxicology and confirmatory testing services in addition to routine chemistry panels.
Service breadth includes women’s health and molecular diagnostics: high Medicaid revenues for 88175 (Pap with thin‑prep workflow, $3.2M, rank #2 in‑state), HPV 87624 ($2.0M), and molecular BV/algorithmic assays 81514 ($2.8M, rank #1 in‑state) point to substantial gynecologic screening and molecular test capacity. Coupled with broad STD NAAT volumes (87491/87591), the lab serves large preventive and public‑health testing lines.
This NPI has long tenure in the dataset (NPI enumerated 2006-06-16, ~20 years ago), supporting interpretation that the observed high volumes and leaderboard ranks reflect an established, sustained testing operation rather than a short‑term surge. The combination of long tenure and consistent outlier status across many routine and specialized codes strengthens the signal that this is a mature, high‑throughput laboratory business serving large Medicaid populations in Texas and substantial Medicare volume nationally.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
550 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. | 437,930 | $10 | $4.4M |
| 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. | 300,040 | $10 | $3.9M |
| 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… | 243,640 | $20 | $3.9M |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 480,230 | $10 | $3.8M |
| 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… | 378,170 | $10 | $3M |
| 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… | 95,890 | $30 | $2.8M |
| 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).… | 211,950 | $10 | $2.1M |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 31,500 | $40 | $1.3M |
| 84403 | The lab analyst performs a test to measure total testosterone, typically in patient serum. | 33,530 | $30 | $838.2K |
| 83880 | The lab analyst measures the amount of natriuretic peptide, a hormone made by heart muscle cells, in the patient specimen. Blood levels of the hormone increase in patients with congestive heart… | 21,060 | $40 | $800.2K |
Showing 1–10 of 550
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 550 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
550 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87637 | 14 | 70 | 40 | $140 | $404.2K |
| 87798 | 176 | 300 | 790 | $30 | $265.1K |
| 87631 | 42 | 90 | 50 | $140 | $90.1K |
| 81279 | 17 | 20 | 270 | $180 | $86.8K |
| 87801 | 114 | 120 | 170 | $70 | $86.5K |
| 83876 | 3 | 10 | 610 | $50 | $80.1K |
| 86003 | 2 | 10 | 8,740 | $10 | $78.5K |
| 87536 | 4 | 10 | 560 | $80 | $75.8K |
| 87481 | 253 | 270 | 150 | $30 | $68.8K |
| U0003 | 7 | 60 | 100 | $70 | $64.7K |
Showing 1–10 of 550
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.
496 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… | 373,790 | $50 | $17.9M |
| 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… | 439,480 | $20 | $10.1M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 453,230 | $20 | $9.1M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 446,050 | $20 | $8.9M |
| 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. | 235,670 | $30 | $7.3M |
| 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. | 1,101,130 | $10 | $5.5M |
| 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… | 434,610 | $10 | $5.2M |
| 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… | 102,460 | $40 | $4.4M |
| 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. | 1,096,180 | $1 | $4.4M |
| 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… | 335,800 | $10 | $4.4M |
Showing 1–10 of 496
How this provider's Medicaid billing volume and revenue compare to other Texas providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Texas median
496 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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,… | 7 | 20 | 950 | $300 | $3.2M |
| 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… | 5 | 20 | 180 | $200 | $923K |
| 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… | 2 | 20 | 250 | $40 | $821.3K |
| 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 | 340 | 400 | $50 | $553.5K |
| 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)… | 68 | 120 | 340 | $120 | $422K |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 65 | 70 | 970 | $80 | $383.3K |
| 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… | 10 | 160 | 200 | $110 | $323.8K |
| 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… | 3 | 160 | 200 | $280 | $321.8K |
| 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… | 2 | 150 | 170 | $30 | $302.9K |
| 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… | 22 | 240 | 420 | $30 | $296.8K |
Showing 1–10 of 496
Other providers in the same ZIP code as Clinical Pathology Laboratories, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| A&p Quality Care Medical Limited Partnership | TX | Durable Medical Equipment & Medical Supplies | $0 | $20.1M |
| Exceptional Employment Services, Inc. | TX | Custodial Care Facility | $0 | $12.9M |
| Vinod Alluri | TX | Psychiatry Physician | $187.4K | $88.4K |
| Megan Scanlon | TX | Occupational Therapist | $78.1K | $0 |
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