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NPI 1417924424 · Eatontown, NJ · Clinical Medical Laboratory
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Pathology Solutions LLC is a clinical medical laboratory provider located in Eatontown, New Jersey. This profile covers 8 Medicare and 6 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 | Pathology Solutions LLC |
| Address | 246 Industrial Way West |
| City | Eatontown |
| State | NJ |
| ZIP | 07724 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | March 8, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $5.4M |
| Medicare | $2.4M |
PATHOLOGY SOLUTIONS LLC operates as a high-volume surgical pathology and diagnostic histology lab: the top revenue codes are 88305 (surgical pathology), 88342 (initial single antibody immunohistochemistry), and 88313 (special stains/Group II), which together account for 92.6% of the provider's total Medicare revenue and 86.8% of its total Medicaid revenue. The code mix and descriptions indicate routine accessioning, microscopic interpretation, and heavy use of immunohistochemistry and special stains consistent with a pathology lab that handles large volumes of tumor and biopsy diagnostics.
Revenue concentration is pronounced across both payers. For Medicare, 88305 alone generates $1.4M (59.0% of the provider's Medicare revenue), with 88342 at $436.2K (17.9%) and 88313 at $382.4K (15.7%), and the precomputed top-3 share is 92.6%. For Medicaid, 88305 produces $2.8M (52.7% of Medicaid revenue), 88342 $1.1M (20.8%), and 88313 $712.8K (13.3%), with the top-3 share at 86.8% — underscoring dependence on a narrow set of pathology services.
Payer mix shows Medicaid as the larger revenue source on file: total Medicare revenue is $2.4M while total Medicaid revenue is $5.4M, so Medicaid accounts for the larger share of billed dollars for this provider. This scale difference suggests the practice draws substantial volume from state-covered populations and payer relationships in New Jersey.
The provider is a major competitive player on its highest-volume codes. Nationally for Medicare, 88305 ranks #20 of 14580 (100th percentile, labeled an "extreme outlier"), 88342 ranks #14 of 11370 (100th percentile, "extreme outlier"), and 88313 ranks #21 of 6757 (100th percentile, "extreme outlier"). In-state for Medicaid, 88305 ranks #4 of 209 (99th percentile, "extreme outlier"), 88342 ranks #2 of 133 (99th percentile, "extreme outlier"), and 88313 ranks #2 of 108 (99th percentile, "extreme outlier"). These ranks indicate the provider is operating at volumes far above typical peers for its core pathology services.
Reimbursement profile varies materially by payer and code. For 88305 the average paid/claim is $33 on Medicare versus $50 on Medicaid (claims: 43.6K Medicare, 56.7K Medicaid). For 88342 the average paid/claim is $62 on Medicare versus $37 on Medicaid (claims: 7K Medicare, 30.2K Medicaid). For 88313 the averages are $64 on Medicare versus $26 on Medicaid (claims: 6K Medicare, 27.4K Medicaid). These differences imply payer-specific pricing dynamics that affect per-claim revenue even as volumes differ.
The provider shows additional in-state dominance on related staining codes beyond the top three: 88312 (special stain Group I) reports 19.1K Medicaid claims and $382.1K revenue, ranking #1 of 102 in-state (100th percentile, "extreme outlier"), and 88341 (additional antibody stain) has 6.5K Medicaid claims and $320.7K revenue, ranking #3 of 62 (97th percentile). This pattern reinforces a broad IHC/special-stain service line that is concentrated and highly utilized by Medicaid in-state payers.
The high concentration of revenue in a small set of lab codes implies operational sensitivity to changes in referral patterns, reimbursement, or coding rules for immunohistochemistry and surgical pathology. Given that the top three codes account for 92.6% (Medicare) and 86.8% (Medicaid) of revenue, shifts in utilization or reimbursement for 88305, 88342, or 88313 would materially affect total revenue.
Tenure on file shows sustained operation: the NPI was enumerated on 2006-03-08 (~20 years ago), indicating long-standing presence in the market. Combined with the extreme outlier volume rankings, this suggests an established pathology operation that has scaled its core services over an extended period.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 43,560 | $30 | $1.4M |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 7,040 | $60 | $436.2K |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 5,980 | $60 | $382.4K |
| 88341 | The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified… | 2,040 | $60 | $112.1K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 570 | $80 | $42.7K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 480 | $30 | $13K |
| 88344 | The lab analyst applies a single multiplex antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 60 | $130 | $7.2K |
| 88307 | The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 20 | $220 | $5.2K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.
View: State1 / 2
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.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 56,670 | $50 | $2.8M |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 30,180 | $40 | $1.1M |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 27,410 | $30 | $712.8K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 19,110 | $20 | $382.1K |
| 88341 | The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified… | 6,550 | $50 | $320.7K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 360 | $20 | $7.1K |
How this provider's Medicaid billing volume and revenue compare to other New Jersey providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Jersey median
6 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 4 | 210 | 1,660 | $60 | $347.9K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 2 | 130 | 800 | $30 | $72.6K |
| 88341 | The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified… | 3 | 60 | 330 | $50 | $66.9K |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 2 | 110 | 350 | $30 | $50.5K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 63 | 110 | 580 | $20 | $44.7K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 1 | 100 | 370 | $30 | $34.4K |
Other providers in the same ZIP code as Pathology Solutions LLC, ranked by combined Medicare and Medicaid revenue.
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