Loading...
NPI 1235533779 · Reisterstown, MD · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Realtox Labs, LLC is a clinical medical laboratory provider located in Reisterstown, Maryland. This profile covers 26 Medicare and 75 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 | Realtox Labs, LLC |
| Address | 200 Business Center Dr |
| City | Reisterstown |
| State | MD |
| ZIP | 21136 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | October 13, 2014 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $9.2M |
| Medicare | $6.6M |
REALTOX LABS, LLC bills materially to both Medicaid and Medicare, with Total Medicare revenue: $6.6M and Total Medicaid revenue: $9.2M. Medicaid represents the larger payer relationship by scale, so payer-negotiation or state-level contract changes could have outsized impact compared with federal Medicare shifts. The NPI was enumerated 2014-10-13 (~12 years ago), indicating an established operation rather than a recent market entrant.
Revenue is highly concentrated into a few test categories for each payer: the precomputed top-three codes account for 73.8% of this provider's total Medicare revenue and 62.7% of this provider's total Medicaid revenue. That concentration means most of the provider’s financial performance is driven by a small set of services—changes to reimbursement, coding edits, or demand for those services would disproportionately affect overall revenues.
The provider’s Medicare business is dominated by high-volume amplified nucleic acid probe tests: 87798 ($3.5M, 53.0% of this provider's total Medicare revenue) and 87481 ($1M, 15.8%) are the top drivers, supported by complementary NAATs such as 87635 and 87640. Several of these molecular-test codes are characterized as extreme outliers versus national peers (for example, 87798 ranks #13 of 1319 nationally at the 99th percentile and 87481 ranks #11 of 1117 nationally at the 99th percentile), indicating the provider runs unusually large volumes of NAAT-based infectious-disease testing in the Medicare market. Those same code types (e.g., multiplex respiratory and SARS–CoV–2 testing) appear throughout the Medicare top-25 list.
On Medicaid, the largest revenue contributors show a dual focus on high-throughput SARS–CoV–2 testing and definitive drug testing: U0003 ($2.2M, 24.4% of this provider's total Medicaid revenue) and G0480 ($2.1M, 23.4%) are roughly equal contributors and rank highly in-state (U0003 #4 of 83, 96th percentile; G0480 #4 of 58, 95th percentile). The Medicaid top codes indicate the laboratory operates significant high-throughput COVID testing capabilities alongside large-volume drug-confirmation services, making it a major in-state supplier for both service lines.
Competitive standing differs by payer and code: nationally the practice is a major outlier on several NAAT codes (for example, 87651 ranks #10 of 3530 nationally at the 100th percentile and 87635 ranks #38 of 9976 nationally at the 100th percentile), signaling unusually high Medicare volumes for those assays. At the state level the lab also shows dominance for multiple panels and drug-testing codes—examples include G0483 for Medicaid where it ranks #1 of 14 in-state (100th percentile) and 87798 which ranks #2 of 37 in-state (97th percentile)—supporting the interpretation that REALTOX is a leading local provider for specific molecular and toxicology services.
The code mix shows a bifurcated service offering: extensive molecular infectious-disease testing (multiple NAATs such as 87798, 87481, 87635, 87637) combined with a broad drug-testing portfolio (G0483, G0482, G0480 and presumptive screens like 80307). Medicaid volumes (for example, 45.2K claims for U0003 and 44.2K claims for G0480) and Medicare volumes (for example, 102.3K claims for 87798) together paint a picture of a lab set up for both high-throughput public-health diagnostics and routine/definitive toxicology work, rather than a narrow, single-test practice.
Several individual codes are explicitly flagged as statistical outliers or notably above typical volumes in the data; nationally on Medicare multiple NAATs are described as extreme outliers (e.g., 87798 and 87481 at the 99th percentile), and in-state Medicaid rankings include several 100th-percentile positions (for example, G0483 #1 of 14 in-state and respiratory/GBS assays such as 87640 and 87653 at 100th percentile in-state). These labels indicate the provider’s reported volumes are far above typical peers for those tests and should be considered when benchmarking capacity, regional market share, or when modeling sensitivity to payer policy changes.
Because a small number of codes drive the bulk of revenue (see the 73.8% and 62.7% top-three concentrations), REALTOX LABS is operationally and financially sensitive to changes that affect those specific tests—reimbursement cuts, coding reclassifications, or declines in demand for SARS–CoV–2 or certain NAAT assays would disproportionately reduce revenue. Analysts evaluating contracting, utilization management, or prospective audit exposure should prioritize the top-revenue codes (for example, 87798, 87481, U0003, G0480) when assessing the provider’s business stability and negotiating leverage.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
26 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 102,280 | $30 | $3.5M |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 30,520 | $30 | $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… | 1,350 | $240 | $325.7K |
| 87640 | The lab analyst performs the technical lab test to look for Staphylococcus aureus nucleic acid using an amplified probe technique. | 7,910 | $30 | $268.8K |
| 87653 | The lab analyst performs a test for Streptococcus, group B, using amplified nucleic acid probe technique. The amplified probe provides a rapid means to assess colonization by Streptococcus, group B,… | 7,910 | $30 | $268.8K |
| 87651 | The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat. | 7,870 | $30 | $267.4K |
| 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… | 1,210 | $200 | $236.7K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 3,240 | $50 | $162.1K |
| 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… | 1,940 | $70 | $143.7K |
| 87186 | The lab analyst performs the technical steps to evaluate a culture isolate’s susceptibility, or sensitivity, to multiple antimicrobial agents, commonly called antibiotics, by observing growth of the… | 10,590 | $10 | $84.7K |
Showing 1–10 of 26
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
26 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87798 | 1 | 60 | 1,430 | $30 | $170.3K |
| G0483 | 2 | 30 | 140 | $240 | $81.9K |
| 81514 | 1 | 10 | 270 | $250 | $67.3K |
| 87088 | 5 | 10 | 40 | $10 | $62.1K |
| 87563 | 3 | 10 | 510 | $30 | $58.5K |
| 87481 | 1 | 60 | 160 | $30 | $48.7K |
| G0481 | 59 | 100 | 130 | $150 | $40.5K |
| 87186 | 3 | 20 | 670 | $10 | $39.6K |
| 87637 | 5 | 20 | 130 | $140 | $39.5K |
| G0482 | 1 | 90 | 100 | $190 | $36.6K |
Showing 1–10 of 26
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.
75 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… | 45,180 | $50 | $2.2M |
| 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… | 44,210 | $50 | $2.1M |
| 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… | 17,670 | $80 | $1.4M |
| 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. | 12,890 | $50 | $657.5K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 13,470 | $40 | $525.3K |
| 87799 | The lab analyst performs a test to quantify infection with an infectious agent, not otherwise specified in another code, using a nucleic acid probe technique. Use this code if you know the laboratory… | 7,570 | $60 | $454.3K |
| 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)… | 3,420 | $80 | $266.6K |
| 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… | 9,680 | $20 | $222.6K |
| 87632 | The lab analyst performs a test to identify a respiratory virus using an amplified nucleic acid probe technique. He may also use the multiplex reverse transcription technique. The provider does this… | 5,620 | $30 | $185.6K |
| 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… | 4,010 | $40 | $168.5K |
Showing 1–10 of 75
How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland median
75 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 23 | 50 | 3,420 | $110 | $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… | 4 | 80 | 500 | $70 | $691.2K |
| 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… | 4 | 60 | 780 | $80 | $613.1K |
| 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. | 22 | 160 | 980 | $50 | $387.6K |
| 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… | 19 | 60 | 250 | $100 | $299.5K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 9 | 50 | 660 | $30 | $289.2K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 10 | 50 | 640 | $30 | $284.4K |
| 87799 | The lab analyst performs a test to quantify infection with an infectious agent, not otherwise specified in another code, using a nucleic acid probe technique. Use this code if you know the laboratory… | 2 | 10 | 1,650 | $30 | $225.2K |
| 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)… | 5 | 40 | 150 | $90 | $192.4K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 13 | 30 | 1,010 | $20 | $152.5K |
Showing 1–10 of 75
Other providers in the same ZIP code as Realtox Labs, LLC, ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.