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NPI 1447296272 · Chantilly, VA · Clinical Medical Laboratory
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Quest Diagnostics Nichols Institute, Inc. is a clinical medical laboratory provider located in Chantilly, Virginia. This profile covers 225 Medicare and 436 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 Nichols Institute, Inc. |
| Address | 14225 Newbrook Dr |
| City | Chantilly |
| State | VA |
| ZIP | 20151 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | June 21, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $46.9M |
| Medicare | $2.3M |
Provider is heavily Medicaid‑weighted: reported Total Medicare revenue is $2.3M versus Total Medicaid revenue of $46.9M, indicating Medicaid represents the dominant share of billing activity and scale for this NPI. This makes the entity effectively Medicaid‑focused in dollar terms rather than balanced between the two payers.
Medicare revenue is highly concentrated in a small set of specialized cytology/flow‑cytometry services: the precomputed top 3 Medicare codes account for 75.4% of Medicare revenue, driven by 88185 ($842K, 39.5%), 88121 ($620.4K, 29.1%), and 88184 ($147.1K, 6.9%). That mix signals a specialty technical laboratory operation that emphasizes flow cytometry and molecular/cell‑level diagnostic assays for Medicare patients.
Medicaid revenue is driven by a mix of very high‑volume screening, molecular and genetic tests: the precomputed top 3 Medicaid codes account for 33.9% of Medicaid revenue, led by 87799 ($5.3M, 14.2%), 81420 ($3.8M, 10.3%), and 80307 ($3.5M, 9.4%). This indicates both high‑throughput infectious disease/NAAT testing and higher‑complexity genomic panels are major business lines on the Medicaid side.
Despite modest absolute Medicare dollars, the provider is a national leader in several specialized Medicare codes: 88185 ranks #11 of 618 (98th percentile; extreme outlier), 88121 ranks #2 of 104 (99th percentile; extreme outlier), and 88184 ranks #7 of 616 (99th percentile; extreme outlier). These ranks show unusually high national penetration on specific cytometry and molecular pathology services compared with peers.
On the Medicaid side the provider is routinely the top in‑state performer for numerous categories: examples include 87799 (rank #1 of 11, 100th percentile; extreme outlier), 81420 (rank #1 of 6, 100th percentile), and G0480 (rank #1 of 95, 100th percentile), with many other codes at #1 or in extreme outlier status. Those statewide leadership positions across diagnostic classes imply dominant market share in Virginia Medicaid for both high‑volume screening and higher‑complexity testing.
The operation combines high‑complexity molecular/genomic testing (examples include 81420 and 81220) with very large‑scale screening and toxicology volumes (examples include 87799, 80307, G0480, and numerous NAAT STI codes such as 87801, 87491, 87591). This blended code mix suggests a lab that supports both specialized diagnostic referrals and large public‑health or population screening workflows.
NPI tenure is long: this NPI was enumerated 2006‑06‑21 (~20 years ago), indicating an established presence in the market. Combined with the large Medicaid footprint ($46.9M) and national outlier positions on select Medicare codes, the tenure supports that these patterns reflect sustained operational focus rather than a short‑term spike.
Concentration and outlier status create clear strategic implications for payers and competitors: heavy Medicare concentration in a few specialized codes (top 3 = 75.4%) and dominant in‑state Medicaid volumes make the provider a critical network lab for specific services. Those same concentrations (many codes labeled “extreme outlier” or “100th percentile”) are important signals for capacity planning, contract negotiations, and comparative benchmarking by both payer and provider analysts.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
225 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 88185 | The lab analyst performs the technical component of a flow cytometry procedure using cell surface, cytoplasmic, or nuclear markers to characterize cells and aid clinicians in diagnosing patients with… | 36,610 | $20 | $842K |
| 88121 | The lab analyst performs a technical lab test on a urinary tract specimen using in situ hybridization and three to five molecular probes for computer assisted morphometric analysis, looking at the… | 1,730 | $360 | $620.4K |
| 88184 | The lab analyst performs the technical component of a flow cytometry procedure using a cell surface, cytoplasmic, or nuclear marker to characterize cells and aid clinicians in diagnosing patients… | 2,130 | $70 | $147.1K |
| 88189 | The clinician, typically a pathologist, interprets flow cytometry results of 16 or more markers. | 1,750 | $70 | $126.1K |
| 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… | 770 | $110 | $84.9K |
| 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. | 710 | $60 | $43.2K |
| 88377 | The lab analyst applies a single multiplex in situ hybridization probe stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a… | 180 | $190 | $35.3K |
| 80503 | At the request of a physician or other qualified healthcare provider, the pathologist performs a consultation for a clinical problem requiring straightforward medical judgment to help clarify… | 900 | $20 | $20.8K |
| 81206 | The lab analyst performs the technical lab test to evaluate the major breakpoint gene sequence BCR/ALB1 that occurs on chromosome 22 due to translocation, which involves breakage and reforming of an… | 120 | $160 | $20K |
| 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… | 300 | $60 | $19.2K |
Showing 1–10 of 225
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 225 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
225 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87798 | 31 | 30 | 690 | $30 | $159.2K |
| 88121 | 1 | 10 | 250 | $340 | $158.9K |
| G0483 | 8 | 10 | 110 | $240 | $67.6K |
| 88185 | 1 | 60 | 620 | $20 | $34.3K |
| 86235 | 6 | 10 | 460 | $20 | $23.8K |
| G0480 | 1 | 10 | 140 | $110 | $23.5K |
| 80307 | 8 | 40 | 80 | $60 | $21.7K |
| 88377 | 4 | 20 | 40 | $80 | $19.6K |
| 81279 | 1 | 10 | 100 | $180 | $18.7K |
| 87799 | 3 | 10 | 360 | $40 | $17.2K |
Showing 1–10 of 225
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
436 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 154,600 | $30 | $5.3M |
| 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,… | 6,690 | $570 | $3.8M |
| 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. | 116,480 | $30 | $3.5M |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 102,760 | $30 | $3.5M |
| 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… | 101,420 | $30 | $2.9M |
| 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… | 10,810 | $270 | $2.9M |
| 87512 | The lab analyst performs a test to quantify infection with Gardnerella vaginalis using nucleic acid probe technique. Gardnerella vaginalis, typically causes bacterial vaginosis, an infection of the… | 97,780 | $20 | $2.2M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 102,100 | $20 | $1.6M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 103,150 | $10 | $1.3M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 103,050 | $10 | $1.3M |
Showing 1–10 of 436
How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Virginia median
436 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,… | 1 | 10 | 290 | $550 | $797.9K |
| 87512 | The lab analyst performs a test to quantify infection with Gardnerella vaginalis using nucleic acid probe technique. Gardnerella vaginalis, typically causes bacterial vaginosis, an infection of the… | 1 | 10 | 930 | $20 | $753.9K |
| 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… | 5 | 20 | 3,960 | $130 | $730.9K |
| 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… | 1 | 10 | 1,000 | $30 | $502.2K |
| 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… | 11 | 20 | 1,220 | $110 | $459.9K |
| 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. | 2 | 170 | 3,790 | $40 | $415.2K |
| 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 | 900 | $190 | $390.3K |
| 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… | 5 | 20 | 1,790 | $70 | $347.5K |
| 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… | 7 | 110 | 1,150 | $40 | $331.1K |
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 2 | 10 | 5,750 | $50 | $243.5K |
Showing 1–10 of 436
Other providers in the same ZIP code as Quest Diagnostics Nichols Institute, Inc., ranked by combined Medicare and Medicaid revenue.
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