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NPI 1457341851 · San Luis Obispo, CA · Clinical Medical Laboratory
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Pacific Point Laboratories, Inc. is a clinical medical laboratory provider located in San Luis Obispo, California. This profile covers 421 Medicare and 362 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 | Pacific Point Laboratories, Inc. |
| Address | 3701 S Higuera St Ste 200 |
| City | San Luis Obispo |
| State | CA |
| ZIP | 93401 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | October 26, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $38.8M |
| Medicare | $8.5M |
This provider is Medicaid‑dominant by scale: lifetime Medicare revenue is $8.5M while lifetime Medicaid revenue is $38.8M, so Medicaid represents the much larger revenue stream for the business. Analysts should treat Medicaid trends as the primary driver of the provider’s overall financial profile rather than Medicare activity.
Medicare revenue is concentrated in routine specimen collection and common chemistry panels: the top three Medicare codes 36415, 80053, and 80061 account for 32.7% of this provider's total Medicare revenue. Those three codes individually generate $685.2K, $634.7K, and $605.4K in Medicare revenue respectively, signaling a high‑throughput outpatient phlebotomy and core lab panel operation.
For Medicare the provider shows unusually large national volumes on several common lab codes: 36415 (85.6K claims, $685.2K revenue) ranks #50 of 86467 providers nationally (100th percentile; extreme outlier), 80053 (63.5K claims, $634.7K revenue) ranks #59 of 26416 (100th percentile; extreme outlier), and 80061 (46.6K claims, $605.4K revenue) ranks #50 of 21671 (100th percentile; extreme outlier). These rank/percentile labels indicate the provider operates at a national scale for specimen collection and routine panels compared with most labs.
Medicaid revenue is highly concentrated in COVID molecular testing plus routine chemistries: U0003 accounts for $8.1M (28.3% of Medicaid revenue), with 119.3K claims, and the next two top Medicaid codes are 82306 ($2.1M) and 80053 ($1.9M); together the top 3 Medicaid codes account for 42.2% of this provider's total Medicaid revenue. This mix shows reliance on high‑throughput SARS‑CoV‑2 NAAT testing alongside large volumes of vitamin D and CMP testing in the state payer channel.
Within the state Medicaid market the provider is a major in‑state player on key tests: U0003 ranks #19 of 751 providers in-state (98th percentile), 82306 ranks #8 of 1109 (99th percentile), and 80053 ranks #10 of 1717 (99th percentile). Those in‑state percentiles indicate the provider is competitively strong in both pandemic molecular testing and high‑volume routine assays relative to California peers.
The provider’s code mix evidences a broad clinical lab service line beyond routine panels: Medicaid and Medicare line items include molecular infectious assays (U0003, U0005), STD NAATs (87491, 87591), allergen IgE testing (86003), endocrine and vitamin testing (84443, 82306, 84439), and culture/susceptibility work (87086, 87186). That diversity suggests the lab supports a mix of population screening, infectious disease diagnostics, and specialty immunology/endocrine services for its ordering network.
Operational profile signals a throughput‑focused model with many high‑claim, low‑unit‑price services alongside select higher‑paid assays: for Medicare 36415 shows 85.6K claims at $8 avg paid/claim and for Medicaid 36415 shows 100.4K claims at $4 avg paid/claim, reflecting large volumes of phlebotomy revenue; by contrast Medicaid 86003 generated $1.9M at $99 avg paid/claim, showing the provider also captures higher‑margin specialized testing. This combination is consistent with a centralized lab processing high specimen volumes while layering in higher‑priced molecular or specialty assays.
The provider has long tenure in Medicare/Medicaid networks, with an NPI enumerated on 2005-10-26 (~21 years ago), indicating an established operation and multi‑year participation in public payer programs that contextualizes the sustained high volumes reported across both payers.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
421 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 85,650 | $10 | $685.2K |
| 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. | 63,470 | $10 | $634.6K |
| 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. | 46,570 | $10 | $605.4K |
| 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… | 36,540 | $20 | $584.7K |
| 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… | 18,020 | $30 | $522.6K |
| 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… | 64,230 | $10 | $513.9K |
| 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).… | 32,230 | $10 | $322.3K |
| 84153 | The lab analyst performs testing for total prostate specific antigen, PSA, typically on serum or plasma samples using laboratory analyzers. PSA is a protein the prostate gland produces, and… | 10,370 | $20 | $186.6K |
| 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… | 6,220 | $30 | $180.4K |
| 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. | 4,200 | $40 | $167.8K |
Showing 1–10 of 421
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 421 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
421 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87798 | 83 | 110 | 1,340 | $30 | $338.2K |
| U0003 | 82 | 130 | 730 | $70 | $246.4K |
| 88185 | 33 | 40 | 1,560 | $20 | $139.2K |
| G0480 | 15 | 50 | 70 | $110 | $119.4K |
| 86235 | 5 | 60 | 1,220 | $20 | $75.7K |
| U0005 | 99 | 150 | 780 | $20 | $75.1K |
| 87481 | 36 | 100 | 270 | $30 | $72.7K |
| 87799 | 9 | 20 | 420 | $40 | $72.5K |
| 87636 | 38 | 90 | 40 | $140 | $70.6K |
| 80307 | 45 | 150 | 220 | $60 | $69.2K |
Showing 1–10 of 421
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.
362 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… | 119,300 | $70 | $8.1M |
| 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… | 129,140 | $20 | $2.1M |
| 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. | 275,500 | $10 | $1.9M |
| 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… | 18,950 | $100 | $1.9M |
| 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… | 179,470 | $10 | $1.6M |
| 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. | 222,910 | $10 | $1.6M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 63,030 | $20 | $1.3M |
| 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… | 308,690 | $1 | $1.2M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 61,920 | $20 | $1.1M |
| 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).… | 208,160 | $10 | $1M |
Showing 1–10 of 362
How this provider's Medicaid billing volume and revenue compare to other California providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. California median
362 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 16 | 110 | 190 | $140 | $1.6M |
| 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… | 19 | 750 | 950 | $50 | $890K |
| 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,… | 43 | 60 | 400 | $40 | $748.5K |
| 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… | 6 | 50 | 190 | $40 | $483.7K |
| 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. | 48 | 660 | 1,490 | $30 | $417.2K |
| 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… | 190 | 340 | 970 | $40 | $343.6K |
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 119 | 280 | 730 | $90 | $315.5K |
| 80321 | The lab analyst detects and measures the alcohol biomarker in a patient specimen. Alcohol biomarkers are physiological indicators of the alcohol exposure or ingestion. In this test, the analyst tests… | 9 | 20 | 290 | $10 | $304.6K |
| 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… | 195 | 290 | 220 | $210 | $268.3K |
| 80373 | The lab analyst measures the amount of or detects the presence of tramadol, which is a centrally acting opioid pain medication, in the patient specimen. | 8 | 20 | 290 | $1 | $223.4K |
Showing 1–10 of 362
Other providers in the same ZIP code as Pacific Point Laboratories, Inc., ranked by combined Medicare and Medicaid revenue.
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