Loading...
NPI 1245382753 · Portland, OR · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Kaiser Foundation Health Plan Of The Northwest is a clinical medical laboratory provider located in Portland, Oregon. This profile covers 96 Medicare and 185 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 | Kaiser Foundation Health Plan Of The Northwest |
| Address | 13705 Ne Airport Way |
| City | Portland |
| State | OR |
| ZIP | 97230 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | January 17, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $61.7M |
| Medicare | $174.4K |
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST operates as a high-volume clinical medical laboratory: its Medicaid billing shows heavy throughput for infectious disease and molecular tests (U0004: 58.5K claims, $4.3M revenue; 87491: 40.6K claims, $4.2M revenue; 87591: 40.5K claims, $4.2M revenue) alongside routine chemistry and hematology panels (80053, 80061, 85025) and drug-testing codes (G0480, 80307). This mix is consistent with a centralized diagnostic lab that processes large screening volumes and NAAT/PCR workloads in addition to standard outpatient lab services.
Revenue concentration is moderate rather than narrowly concentrated: the top 3 Medicare codes account for 28.1% of total Medicare revenue and the top 3 Medicaid codes account for 28.7% of total Medicaid revenue. Those precomputed shares indicate meaningful dependence on a handful of high-volume tests while still leaving substantial revenue distributed across many other codes.
The provider is effectively Medicaid‑centric: lifetime Medicaid revenue of $61.7M far exceeds lifetime Medicare revenue of $174.4K, indicating that Medicaid is the dominant payer by scale for this NPI. Analysts should treat Medicare activity as a relatively small adjunct to a much larger Medicaid testing operation rather than as a balanced two‑payer mix.
In-state competitive standing is strong and concentrated: multiple Medicaid codes rank at or near the top of state peers — for example, 87636 ranks #1 of 22 providers in-state (100th percentile), G0328 ranks #1 of 10 providers (100th percentile), and 85027 ranks #1 of 75 providers (100th percentile). High state percentiles for core testing lines (87491 and 87591 at the 96th percentile, 84443 at the 98th percentile, 83036 at the 99th percentile) indicate the provider is a major regional supplier for STI screening, thyroid testing, and diabetes monitoring.
National Medicare footprint is modest with pockets of above‑typical volume: Medicare ranks for G0480 (#537, 66th percentile) and 80307 (#1494, 69th percentile) are middling nationally, while other Medicare codes such as 83036 (99th percentile) and 80053 (94th percentile) show unusually high volumes for specific routine assays. Overall Medicare revenue is small ($174.4K), so the provider’s national influence appears limited to selected assays rather than broad national market share.
Several specific codes are flagged as statistical outliers in-state, reflecting exceptionally high volumes for particular services: 84443 is labeled an "extreme outlier, far above typical state volume," 83036 and 82728 are also at very high state percentiles, and multiple molecular/NAAT codes (U0004, 87636) sit at or near the top of state rankings. These outlier flags indicate operational concentration in those test lines and potential leverage in Medicaid contracting for those services.
The presence of both high-reimbursement molecular panels (81420 at $1.7M on Medicaid) and high-claim-volume NAATs and PCRs (U0004: 58.5K claims; 87491/87591: ~40K claims each) implies the lab supports complex, higher-cost testing alongside mass-screening assays. For payers, this signals that negotiations or utilization reviews should distinguish between high-cost genomic/molecular workups and high-volume screening services.
The NPI tenure (enumerated 2007-01-17, ~19 years ago) indicates a long-established operation; combined with the large Medicaid revenue base ($61.7M) and top-in-state ranks on multiple codes, this suggests the provider is an entrenched lab partner within the state Medicaid ecosystem rather than a recent entrant. Tenure supports the likelihood of ongoing contractual relationships and existing processing capacity for high-volume Medicaid testing.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
96 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 140 | $100 | $14K |
| 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. | 250 | $50 | $12.4K |
| 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… | 680 | $20 | $10.8K |
| 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. | 1,000 | $10 | $10K |
| 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).… | 900 | $10 | $9K |
| 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… | 920 | $10 | $7.3K |
| 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… | 1,040 | $10 | $7.3K |
| 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. | 430 | $10 | $5.5K |
| 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… | 100 | $50 | $4.5K |
| 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… | 150 | $30 | $4.1K |
Showing 1–10 of 96
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 96 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
185 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by… | 58,500 | $70 | $4.3M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 40,590 | $100 | $4.2M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 40,540 | $100 | $4.2M |
| 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… | 77,250 | $40 | $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. | 21,470 | $130 | $2.7M |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 15,540 | $160 | $2.5M |
| 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. | 63,250 | $30 | $2.1M |
| 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).… | 88,090 | $20 | $2M |
| 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… | 30,760 | $60 | $1.9M |
| 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… | 9,310 | $190 | $1.7M |
Showing 1–10 of 185
How this provider's Medicaid billing volume and revenue compare to other Oregon providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Oregon median
185 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by… | 2 | 10 | 1,790 | $60 | $1.8M |
| 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,… | 3 | 10 | 1,200 | $690 | $770.6K |
| 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… | 8 | 60 | 420 | $60 | $405.1K |
| 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… | 8 | 60 | 460 | $40 | $327.4K |
| 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. | 7 | 80 | 1,210 | $40 | $294.3K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 10 | 90 | 530 | $50 | $281.6K |
| 87506 | The lab analyst performs a test to detect six to eleven types or subtypes of a pathogen, such as Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia, that cause gastrointestinal… | 1 | 10 | 290 | $590 | $276.3K |
| 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,… | 1 | 10 | 370 | $300 | $259.6K |
| 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 | 390 | $120 | $240.6K |
| 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… | 3 | 10 | 330 | $50 | $191.7K |
Showing 1–10 of 185
Other providers in the same ZIP code as Kaiser Foundation Health Plan Of The Northwest, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Quest Diagnostics Clinical Laboratories Inc | OR | Clinical Medical Laboratory | $226.9K | $21.8M |
| Albertina Kerr Centers | OR | Community/Behavioral Health Agency | $0 | $15M |
| Apria Healthcare LLC | OR | Durable Medical Equipment & Medical Supplies | $0 | $9.4M |
| Kan-di-ki, LLC | OR | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | $82.1K | $268K |
| Walgreen Co | OR | Pharmacy | $58.6K | $70 |
| Carmen Winters | OR | Anatomic Pathology & Clinical Pathology Physician | $36.7K | $0 |
| Zheru Liu | OR | Anatomic Pathology & Clinical Pathology Physician | $630 | $0 |
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.