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NPI 1447760814 · Pine Brook, NJ · Clinical Medical Laboratory
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P4 Clinical LLC is a clinical medical laboratory provider located in Pine Brook, New Jersey. This profile covers 199 Medicare and 104 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 | P4 Clinical LLC |
| Address | 25 Riverside Dr Unit 10 |
| City | Pine Brook |
| State | NJ |
| ZIP | 07058 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | October 11, 2017 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.6M |
| Medicaid | $964K |
P4 CLINICAL LLC is primarily a Medicare-facing clinical laboratory by scale: it reported $4.6M in total Medicare revenue versus $964K in total Medicaid revenue, so Medicare represents the dominant portion of its publicly reported payer mix. The provider’s NPI has been enumerated since 2017-10-11 (~9 years ago), indicating an established lab operation with several years of claims history.
The provider’s service mix is heavily weighted toward molecular and nucleic-acid amplification testing: its largest Medicare revenue source is 87798 (42.2K claims, $1.4M revenue; 37.8% of Medicare revenue), and other top Medicare pieces include 87481 and 87506, which together reflect routine infectious-disease NAAT workflows. On the Medicaid side, U0003 (13.4K claims, $657.3K revenue; 70.1% of Medicaid revenue) dominates, pointing to high-throughput SARS-CoV-2 PCR capacity and a lab footprint oriented toward infectious‑disease diagnostics.
Revenue concentration is material for both payers: precomputed top-3 Medicare codes by revenue account for 52.7% of this provider's total Medicare revenue, and precomputed top-3 Medicaid codes by revenue account for 83.9% of this provider's total Medicaid revenue. For Medicare the single largest code is 87798 (37.8% of Medicare revenue), while Medicaid revenue is overwhelmingly concentrated in U0003 (70.1% of Medicaid revenue), indicating asymmetric dependence on a few high-volume tests.
Medicaid positioning shows strong dependence on COVID-era testing volumes: U0003 alone is 70.1% of Medicaid revenue and U0005 adds another 8.6%, together forming the bulk of Medicaid billing. Both U0003 (ranks #40 of 127 in-state, 69th percentile) and U0005 (ranks #67 of 142 in-state, 53rd percentile) are described as typical, unremarkable volume relative to in-state peers, which suggests the provider’s high Medicaid dollar share comes from long sustained test volumes rather than extreme in-state dominance.
Competitive standing on specific Medicare codes is mixed: for several commonly billed laboratory panels and analytes (e.g., 80053, 85025, 83036) the provider ranks in very high national percentiles but is labeled as typical, unremarkable volume, indicating large absolute claim counts but not necessarily atypical for a lab of this size. Conversely, certain molecular targets show above-typical behavior — for example, 87563 (Medicare) is flagged as notably above typical national volume, and 87651 is also described as notably above typical national volume — signaling pockets of relative specialization in select NAATs.
The presence of P9604 (3.1K claims, $34.3K revenue; 0.9% of Medicare revenue) in the Medicare top codes and substantial claim counts for specimen-driven services indicate operational capacity for home- or facility-based specimen collection and logistics. That travel allowance billing, combined with high-throughput molecular codes, suggests the lab supports outreach or point-of-care specimen collection workflows in addition to central testing.
There is programmatic diversification beyond high‑volume molecular assays: Medicare billing includes surgical pathology (88305: 5.2K claims, $187.2K revenue; 4.9% of Medicare revenue) and immunohistochemistry/slide staining codes (88313, 88342) while Medicaid claims also reflect routine panels (80053, 85025) at lower per-claim payments. These non‑molecular lines produce meaningful revenue slices but remain secondary to the lab’s infectious‑disease NAAT focus.
From a payer-risk perspective, the provider’s large Medicaid exposure to a single pandemic-era code (U0003 = 70.1% of Medicaid revenue) and Medicare concentration (top 3 codes = 52.7% of Medicare revenue) create sensitivity to changes in test demand, coding guidance, or reimbursement for a small set of high-volume assays. Analysts should treat future shifts in infectious-disease testing demand or policy as high-impact levers on this provider’s near-term revenue profile.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
199 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 42,210 | $30 | $1.4M |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 9,710 | $30 | $330.2K |
| 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… | 920 | $260 | $236.2K |
| 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… | 5,200 | $40 | $187.2K |
| 87556 | The lab analyst performs a test for Mycobacterium tuberculosis using amplified nucleic acid probe technique. Mycobacteria tuberculosis are sometimes called acid fast bacteria because of the special… | 3,200 | $40 | $131.1K |
| 87563 | he lab analyst performs a test on a patient specimen such as blood, for Mycoplasma genitalium antigen detection using amplified nucleic acid probe technique. | 3,240 | $30 | $110K |
| 87640 | The lab analyst performs the technical lab test to look for Staphylococcus aureus nucleic acid using an amplified probe technique. | 3,230 | $30 | $109.7K |
| 87653 | The lab analyst performs a test for Streptococcus, group B, using amplified nucleic acid probe technique. The amplified probe provides a rapid means to assess colonization by Streptococcus, group B,… | 3,210 | $30 | $109.1K |
| 87651 | The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat. | 3,200 | $30 | $108.6K |
| 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,… | 1,500 | $70 | $100.4K |
Showing 1–10 of 199
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 199 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
199 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| G0471 | 4 | 10 | 25,620 | $10 | $699.5K |
| 87506 | 3 | 10 | 110 | $260 | $506.1K |
| 87798 | 3 | 40 | 1,760 | $30 | $284.3K |
| 88120 | 9 | 20 | 200 | $350 | $278K |
| P9603 | 4 | 10 | 11,620 | $1 | $245.2K |
| 86480 | 9 | 20 | 50 | $60 | $110.8K |
| 86235 | 10 | 40 | 160 | $20 | $95.2K |
| 86360 | 6 | 10 | 1,550 | $50 | $93.4K |
| 88121 | 6 | 10 | 180 | $290 | $92.6K |
| 83880 | 10 | 50 | 70 | $40 | $83.4K |
Showing 1–10 of 199
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.
104 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… | 13,410 | $50 | $657.3K |
| U0005 | 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, cdc or non-cdc,… | 6,180 | $10 | $80.3K |
| 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… | 1,940 | $30 | $48.5K |
| 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… | 1,910 | $20 | $30.5K |
| 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… | 3,790 | $1 | $11.4K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 1,600 | $10 | $11.2K |
| 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… | 3,380 | $1 | $10.1K |
| 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… | 420 | $20 | $8.8K |
| 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… | 8,670 | $1 | $8.7K |
| 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. | 8,490 | $1 | $8.5K |
Showing 1–10 of 104
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
104 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 40 | 130 | 3,180 | $60 | $4.2M |
| 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… | 22 | 40 | 590 | $20 | $1.9M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 67 | 120 | 900 | $20 | $971.9K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 65 | 120 | 940 | $20 | $957.4K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 25 | 50 | 400 | $10 | $839.8K |
| U0005 | 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, cdc or non-cdc,… | 67 | 140 | 5,590 | $20 | $823.1K |
| 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… | 23 | 90 | 630 | $30 | $806.2K |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 19 | 30 | 630 | $20 | $687.4K |
| 87624 | The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result. | 36 | 50 | 300 | $20 | $629.9K |
| 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… | 54 | 70 | 510 | $10 | $610.7K |
Showing 1–10 of 104
Other providers in the same ZIP code as P4 Clinical LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Ocean Home Health Supply, LLC | NJ | Durable Medical Equipment & Medical Supplies | $0 | $28M |
| Siparadigm LLC | NJ | Clinical Medical Laboratory | $9.9M | $13.5M |
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