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NPI 1235186800 · Nashville, TN · Clinical Medical Laboratory
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Pathgroup Labs, LLC is a clinical medical laboratory provider located in Nashville, Tennessee. This profile covers 422 Medicare and 373 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 | Pathgroup Labs, LLC |
| Address | 1010 Airpark Center Dr |
| City | Nashville |
| State | TN |
| ZIP | 37217 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | May 28, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $62.1M |
| Medicare | $24.8M |
This lab generates substantially more Medicaid revenue than Medicare revenue, with lifetime Medicaid receipts of $62.1M versus Medicare at $24.8M; it is not a single‑payer operation but clearly Medicaid‑heavy in scale. The provider has been enumerated since 2006-05-28 (~20 years ago), indicating an established presence that aligns with the larger Medicaid footprint.
Revenue concentration is material at the code level for both payers: the top 3 Medicare codes by revenue account for 36.1% of total Medicare revenue, driven by high-revenue items such as 80053 ($2.4M), 82306 ($2.2M) and 84443 ($2.2M). On Medicaid the top 3 codes account for 30.5% of total Medicaid revenue, with 80050 ($5.1M), 82306 ($4.1M) and 80081 ($3.7M) as the leading contributors.
The service mix and code portfolio indicate a high‑throughput clinical reference laboratory focused on routine chemistry and endocrine monitoring plus broad screening and microbiology: high-volume panel codes (80050, 80053, 80061), vitamin D testing (82306), thyroid testing (84443, 84439, 84481) and CBCs (85025) dominate the list. This blend of routine panels, endocrine assays and microbiology culture codes (87086, 87077, 87186) is consistent with a centralized lab processing ambulatory and public‑health screening specimens.
Nationally for Medicare, the provider is a major volume outlier on multiple common tests: codes such as 80053 (ranks #25 of 26416, 100th percentile; extreme outlier), 82306 (ranks #20 of 12453, 100th percentile; extreme outlier) and 84443 (ranks #23 of 19722, 100th percentile; extreme outlier) all sit at the top of national distributions. Those rankings and the repeated “extreme outlier” label signal that this entity operates at volumes far above typical national peers for these routine diagnostics.
Within Tennessee Medicaid the provider is frequently the statewide volume leader: 80050 (298.4K claims, $5.1M revenue) ranks #1 of 38 providers in-state (100th percentile; extreme outlier), 82306 (376.3K claims, $4.1M revenue) ranks #1 of 117 (100th percentile; extreme outlier), and 80061 (564.3K claims, $2.8M revenue) ranks #1 of 222 (100th percentile; extreme outlier). This pattern — many top codes at rank #1 in-state and labeled “extreme outlier” — indicates dominant market share for routine panel and screening services in-state.
Claim volumes on both payers show very high throughput: examples include Medicaid 85025 with 613.2K claims ($1.8M) and 82306 with 376.3K claims ($4.1M), and Medicare volumes such as 85025 with 188.4K claims ($1.5M) and 80061 with 166.6K claims ($2.2M). Those absolute claim counts coupled with 100th‑percentile rankings support an operational profile optimized for large batch testing and automated analyzers rather than low‑volume specialty consult testing.
The provider also offers higher‑complexity and definitive testing alongside routine panels, as evidenced on Medicaid by G0480 (44.1K claims, $1.4M revenue; ranks #2 of 89 providers in-state, 99th percentile) and by immunoassays such as 86235 (Medicaid $1.2M revenue, ranks #2 of 7 in-state). These items show the lab’s capability to supply both complex toxicology/definitive drug testing and specialized serologic panels in addition to very high-volume screening.
Overall, the combination of a long tenure (enumerated 2006-05-28 (~20 years ago)), outsized in‑state leadership on core panel and screening codes, and national outlier status on many Medicare codes positions PATHGROUP LABS, LLC as a high-volume reference laboratory with particular strength in Medicaid work and routine ambulatory testing. Analysts evaluating network impact or contracting should treat it as a major Medicaid supplier of panel, endocrine, and infectious‑disease screening services rather than a small local laboratory.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
422 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. | 242,360 | $10 | $2.4M |
| 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… | 75,960 | $30 | $2.2M |
| 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… | 136,360 | $20 | $2.2M |
| 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. | 166,600 | $10 | $2.2M |
| 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… | 188,420 | $10 | $1.5M |
| 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. | 30,100 | $40 | $1.2M |
| 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).… | 107,500 | $10 | $967.5K |
| 84153 | The lab analyst performs testing for total prostate specific antigen, PSA, typically on serum or plasma samples using laboratory analyzers. PSA is a protein the prostate gland produces, and… | 34,140 | $20 | $614.5K |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 39,850 | $20 | $597.7K |
| 87086 | Culture, bacterial; quantitative, colony count, urine. | 73,540 | $10 | $588.3K |
Showing 1–10 of 422
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 422 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
422 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 82542 | 3 | 10 | 10,060 | $20 | $237.2K |
| G0481 | 89 | 60 | 80 | $150 | $73.2K |
| 84238 | 2 | 10 | 1,960 | $40 | $70.2K |
| 86481 | 28 | 10 | 680 | $100 | $66.4K |
| 86480 | 3 | 10 | 920 | $60 | $55.7K |
| 86003 | 4 | 10 | 9,380 | $10 | $53.7K |
| 86001 | 2 | 10 | 5,870 | $10 | $45K |
| 80307 | 5 | 250 | 140 | $60 | $30.1K |
| G0480 | 4 | 70 | 80 | $110 | $29.1K |
| 86235 | 2 | 10 | 360 | $20 | $27.6K |
Showing 1–10 of 422
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.
373 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 298,380 | $20 | $5.1M |
| 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… | 376,260 | $10 | $4.1M |
| 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… | 90,710 | $40 | $3.7M |
| 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. | 564,280 | $10 | $2.8M |
| 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. | 107,580 | $30 | $2.7M |
| 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… | 188,940 | $10 | $2.6M |
| 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. | 602,370 | $1 | $2.4M |
| 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… | 341,440 | $10 | $2M |
| 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… | 613,210 | $1 | $1.8M |
| 87086 | Culture, bacterial; quantitative, colony count, urine. | 364,060 | $1 | $1.5M |
Showing 1–10 of 373
How this provider's Medicaid billing volume and revenue compare to other Tennessee providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Tennessee median
373 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 1 | 10 | 13,370 | $40 | $1.1M |
| 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… | 20 | 70 | 180 | $60 | $589.9K |
| 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 | 240 | 840 | $20 | $259.2K |
| 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… | 1 | 40 | 200 | $20 | $234.7K |
| 86235 | The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,… | 2 | 10 | 1,180 | $20 | $209.4K |
| 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 | 90 | 400 | $30 | $189K |
| 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 | 40 | 450 | $10 | $158.2K |
| 86003 | The lab analyst performs the technical lab test to analyze a specimen such as serum for allergen–specific immunoglobulin E (IgE), using a crude allergen extract. The test result is quantitative or… | 2 | 10 | 200 | $10 | $141.1K |
| 80349 | The lab analyst measures the amount of or detects the presence of natural cannabinoids in a patient specimen. | 9 | 10 | 870 | $10 | $107.3K |
| 80074 | The lab analyst performs an acute hepatitis panel; the panel must include tests for hepatitis A IgM antibody, hepatitis B core IgM antibody, hepatitis B surface antigen, and hepatitis C antibody. | 1 | 20 | 310 | $20 | $107K |
Showing 1–10 of 373
Other providers in the same ZIP code as Pathgroup Labs, LLC, ranked by combined Medicare and Medicaid revenue.
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