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NPI 1245307818 · Baltimore, MD · Clinical Medical Laboratory
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Quest Diagnostics Incorporated Md is a clinical medical laboratory provider located in Baltimore, Maryland. This profile covers 542 Medicare and 387 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 Incorporated Md |
| Address | 1715 Twin Springs Rd |
| City | Baltimore |
| State | MD |
| ZIP | 21227 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | November 29, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $121.8M |
| Medicare | $27.3M |
Payer mix is Medicaid‑dominant: the provider reports $121.8M in lifetime Medicaid revenue versus $27.3M in lifetime Medicare revenue, indicating a substantially larger Medicaid footprint in absolute dollars and that Medicaid accounts for the bulk of billed volume and revenue for this entity. This profile suggests the organization operates primarily as a high‑volume Medicaid lab provider in its state rather than as a Medicare‑focused supplier.
Service mix points to a high‑throughput clinical laboratory with both routine outpatient chemistry/phlebotomy and large infectious‑disease/STI testing operations. On the Medicare side the largest revenue drivers are codes tied to phlebotomy and routine panels—36415, 80053, and 80061—while Medicaid shows massive volumes in molecular infectious testing and drug/toxicology work (U0003, G0480, 80307), consistent with a network laboratory that handles both routine chronic‑care monitoring and high volumes of public‑health and screening tests.
Medicare revenue is concentrated: the top three Medicare codes account for 36.4% of total Medicare revenue, led by 36415 (12.6% of Medicare revenue), 80053 (12.3%), and 80061 (11.4%). Each of those codes appears as a primary operational activity for the practice (phlebotomy, CMP, lipid panel), indicating routine outpatient lab work constitutes a large, stable share of the provider’s Medicare business.
Medicaid revenue is even more concentrated at the top: the top three Medicaid codes account for 47.7% of total Medicaid revenue, driven primarily by U0003 (32.1% of Medicaid revenue), G0480 (8.0%), and 80307 (7.6%). U0003 alone represents a single code responsible for nearly a third of Medicaid revenue, signaling heavy dependence on high‑volume SARS‑CoV‑2 testing in the state Medicaid population.
Competitive standing — national Medicare: the provider is an unusually large national claimant on many common lab codes. Examples include 36415 (rank #20 of 86467 providers nationally, 100th percentile; extreme outlier), 80053 (rank #26 of 26416, 100th percentile; extreme outlier), and 80061 (rank #24 of 21671, 100th percentile; extreme outlier), which together indicate the provider is a high‑volume national outlier for routine lab services.
Competitive standing — in‑state Medicaid: the provider is a dominant in‑state player for many Medicaid codes, frequently ranking #1 in Maryland and labeled an extreme outlier for state volume. Illustrative in‑state leadership includes U0003 (rank #1 of 83 providers, 100th percentile; extreme outlier), G0480 (rank #1 of 58 providers, 100th percentile; extreme outlier), 80307 (rank #1 of 159 providers, 100th percentile; extreme outlier), and numerous routine panels that also rank #1 in‑state, showing broad market share across infectious, toxicology and routine lab services.
The provider’s billing pattern shows a significant public‑health and STI screening footprint under Medicaid: very large claim counts for infectious and sexual‑health testing (U0003 376.5K claims; 87491 239K claims; 87591 238.8K claims; 87389 183.7K claims) and high HIV and hepatitis screening activity (86803 120.2K claims). These volumes are consistent with a laboratory performing state‑scale screening and outbreak response work in addition to routine diagnostics.
The NPI shows a long tenure: enumerated 2006-11-29 (~20 years ago), indicating an established operation. Coupled with the high national and in‑state ranks for many codes and the large lifetime revenues reported, the data are consistent with a mature, high‑capacity clinical laboratory infrastructure rather than a small or recently established clinic.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
542 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. | 297,820 | $10 | $2.4M |
| 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. | 233,200 | $10 | $2.3M |
| 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. | 166,300 | $10 | $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… | 123,980 | $20 | $2M |
| 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… | 61,770 | $30 | $1.8M |
| 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… | 190,940 | $10 | $1.5M |
| 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).… | 123,840 | $10 | $1.2M |
| 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. | 17,140 | $40 | $685.6K |
| 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… | 27,150 | $20 | $488.6K |
| 84439 | The lab analyst performs a test to measure free thyroxine, or free T4, typically in patient serum. | 49,230 | $10 | $443.1K |
Showing 1–10 of 542
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 542 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
542 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87900 | 2 | 10 | 110 | $130 | $297.8K |
| 87798 | 59 | 60 | 1,430 | $30 | $170.3K |
| 81513 | 1 | 10 | 1,150 | $140 | $160.9K |
| 87449 | 2 | 10 | 2,100 | $10 | $104.8K |
| 83704 | 1 | 10 | 3,060 | $30 | $102.5K |
| 87506 | 5 | 10 | 210 | $260 | $96.7K |
| G0483 | 10 | 30 | 140 | $240 | $81.9K |
| 83521 | 1 | 10 | 4,670 | $20 | $79K |
| 83698 | 1 | 10 | 1,390 | $50 | $62.9K |
| 87088 | 1 | 10 | 40 | $10 | $62.1K |
Showing 1–10 of 542
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.
387 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… | 376,490 | $80 | $29.4M |
| 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… | 93,570 | $80 | $7.3M |
| 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. | 148,160 | $50 | $7M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 239,030 | $20 | $5.5M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 238,830 | $20 | $5.3M |
| 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. | 447,250 | $10 | $3.1M |
| 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. | 498,600 | $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… | 192,510 | $20 | $2.9M |
| 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… | 183,730 | $20 | $2.8M |
| 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… | 22,400 | $120 | $2.7M |
Showing 1–10 of 387
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
387 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,… | 2 | 10 | 8,770 | $640 | $5.6M |
| 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… | 7 | 50 | 3,420 | $110 | $1.2M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 2 | 10 | 220 | $200 | $1.1M |
| 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 | 80 | 500 | $70 | $691.2K |
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 1 | 10 | 5,010 | $80 | $668.2K |
| 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… | 1 | 60 | 780 | $80 | $613.1K |
| 86008 | The lab analyst performs the technical lab test to analyze a specimen for an allergen specific immunoglobulin E (IgE), using a recombinant or purified allergen component; the result is quantitative… | 2 | 10 | 5,870 | $100 | $589.7K |
| 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 | 10,300 | $50 | $501.9K |
| 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… | 1 | 10 | 180 | $230 | $388.6K |
| 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. | 1 | 160 | 980 | $50 | $387.6K |
Showing 1–10 of 387
Other providers in the same ZIP code as Quest Diagnostics Incorporated Md, ranked by combined Medicare and Medicaid revenue.
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