Loading...
NPI 1295726032 · Birmingham, AL · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Laboratory Corporation Of America Holdings is a clinical medical laboratory provider located in Birmingham, Alabama. This profile covers 540 Medicare and 509 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 | Laboratory Corporation Of America Holdings |
| Address | 1801 1st Ave S |
| City | Birmingham |
| State | AL |
| ZIP | 35233 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | November 1, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $289.1M |
| Medicare | $60.5M |
This entity is predominantly a Medicaid-oriented laboratory in scale: reported Total Medicare revenue is $60.5M while Total Medicaid revenue is $289.1M, indicating Medicaid collections are several-fold larger than Medicare collections for this NPI. Analysts should treat Medicaid activity as the primary revenue stream when assessing network impact or contract exposure.
The provider has long tenure on file, with NPI enumerated 2005-11-01 (~21 years ago), which supports that the high-volume billing patterns reflect an established operation rather than a recent entrant. Longevity increases the likelihood that observed high volumes are the result of sustained business model and network relationships.
The CPT mix shows a classic reference laboratory footprint with very large volumes of routine chemistry, hematology, endocrine, and infectious disease tests: for Medicare this includes high volumes of 80053 (583K claims, $5.8M revenue), 80061 (396.4K claims, $5.2M revenue), 84443 (301.1K claims, $4.8M revenue), 36415 (558.6K claims, $4.5M revenue) and 85025 (464.2K claims, $3.7M revenue). For Medicaid the profile includes extremely large state-level volumes of STD and molecular screening like 87491 (1.1M claims, $21.2M revenue), 87591 (1.1M claims, $21.1M revenue), 80050 (789.1K claims, $16.6M revenue) and high-throughput analytes including 82306 (852.6K claims, $11.1M revenue). This mix implies the operation combines centralized phlebotomy/processing with high-throughput infectious disease and screening platforms.
Revenue concentration is meaningful but not monopolistic: the top 3 Medicare codes by revenue account for 36.2% of the provider's total Medicare revenue, and the top 3 Medicaid codes by revenue account for 29.0% of the provider's total Medicaid revenue. These precomputed shares indicate a reliance on a relatively small set of high-volume tests while still maintaining a broad secondary portfolio.
Nationally for Medicare, the provider is an extreme-volume outlier on many standard lab codes: several high-revenue Medicare codes (for example 80053, 80061, 84443, 36415, 85025) are described as 100th percentile and “extreme outlier” in national rank (e.g., 80053 ranks #6 of 26416 providers nationally). That pattern is consistent with a national reference lab or centralized testing platform that handles much higher per‑provider claim volumes than typical local labs.
At the state level for Medicaid the entity is repeatedly the leading in‑state performer: multiple top Medicaid codes (for example 87491, 87591, 80050, 87661, 82306) rank #1 of providers in-state and are labeled “100th percentile; extreme outlier.” This establishes the provider as a dominant statewide testing service for common screening and infectious disease assays and a primary Medicaid laboratory partner in Alabama.
The presence of higher-cost and specialized molecular/genomic codes alongside high-volume screening supports a vertically broad testing capability: notable examples include 81420 (42.2K claims, $11.7M revenue) and 81220 (23.3K claims, $4.9M revenue) on the Medicaid side, and 81490 on the Medicare side (853 claims, $702.9K revenue) which is characterized as typical rather than anomalous. These entries indicate capacity for prenatal cell‑free DNA and genetic panels in addition to routine panels, which can affect payer strategies for specialty test routing and prior‑authorization.
Operational signals from specimen and routine test volumes point to centralized collection and automation: very high claim counts for specimen collection and routine panels (e.g., 36415 558.6K claims, 85025 464.2K claims, 80061 396.4K claims on Medicare; and 85025 1.5M claims, 80061 1.8M claims on Medicaid) suggest a business model built around mass sample intake and automated processing. For payers and providers this implies the laboratory can handle large redirected volumes but also represents concentrated utilization that should be monitored within network agreements and utilization management programs.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
540 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. | 582,990 | $10 | $5.8M |
| 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. | 396,410 | $10 | $5.2M |
| 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… | 301,130 | $20 | $4.8M |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 558,620 | $10 | $4.5M |
| 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… | 142,390 | $30 | $4.1M |
| 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… | 464,150 | $10 | $3.7M |
| 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).… | 231,980 | $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. | 40,060 | $40 | $1.6M |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 87,540 | $20 | $1.3M |
| 84439 | The lab analyst performs a test to measure free thyroxine, or free T4, typically in patient serum. | 120,390 | $10 | $1.1M |
Showing 1–10 of 540
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 540 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
540 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81490 | 1 | 10 | 850 | $820 | $702.7K |
| G0472 | 1 | 10 | 4,580 | $40 | $187.8K |
| 87536 | 1 | 10 | 2,180 | $80 | $181.4K |
| 86480 | 1 | 10 | 180 | $60 | $116.4K |
| P9603 | 6 | 10 | 23,200 | $1 | $108.3K |
| 87799 | 1 | 10 | 2,510 | $40 | $105.2K |
| G0483 | 5 | 10 | 100 | $240 | $87.4K |
| 81374 | 1 | 10 | 1,040 | $70 | $75.5K |
| 88305 | 16 | 180 | 610 | $40 | $74.2K |
| 86360 | 1 | 10 | 1,490 | $50 | $68.6K |
Showing 1–10 of 540
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.
509 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 1,060,910 | $20 | $21.2M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 1,053,400 | $20 | $21.1M |
| 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… | 789,060 | $20 | $16.6M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 738,700 | $20 | $12.6M |
| 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,… | 42,230 | $280 | $11.7M |
| 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… | 852,600 | $10 | $11.1M |
| 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. | 1,768,110 | $10 | $10.6M |
| 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… | 738,250 | $10 | $10.3M |
| 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… | 129,100 | $70 | $8.9M |
| 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. | 1,654,010 | $10 | $8.3M |
Showing 1–10 of 509
How this provider's Medicaid billing volume and revenue compare to other Alabama providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Alabama median
509 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 2 | 10 | 1,190 | $1,590 | $67M |
| 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,… | 1 | 10 | 21,250 | $280 | $5.9M |
| 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 | 5,570 | $480 | $4.1M |
| 83498 | The lab analyst measures the 17 hydroxyprogesterone in a sample such as blood, serum, urine, or even amniotic fluid. This hormone is a building block for the adrenal cortex hormone cortisol. | 2 | 10 | 21,240 | $30 | $3.8M |
| 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,… | 2 | 10 | 40,330 | $70 | $2.9M |
| 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 | 1,300 | $40 | $1.8M |
| 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… | 5 | 60 | 1,260 | $60 | $1.2M |
| 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… | 71 | 100 | 470 | $130 | $1.2M |
| 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 | 20 | 160 | $20 | $1.1M |
| 83520 | The lab analyst measures the analyte, which is not an infectious agent antibody or infectious agent antigen, by immunoassay. Use 83520 for procedures that have no specific code assigned for the… | 2 | 10 | 140 | $20 | $1.1M |
Showing 1–10 of 509
Other providers in the same ZIP code as Laboratory Corporation Of America Holdings, 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.