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NPI 1487639381 · Saint Paul, MN · Clinical Medical Laboratory
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Medtox Laboratories, Inc is a clinical medical laboratory provider located in Saint Paul, Minnesota. This profile covers 6 Medicare and 79 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 | Medtox Laboratories, Inc |
| Address | 402 County Road D W |
| City | Saint Paul |
| State | MN |
| ZIP | 55112 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | December 13, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $47.7M |
| Medicare | $63.4K |
MEDTOX LABORATORIES, INC is effectively a Medicaid-focused laboratory by scale: it reports $47.7M in total Medicaid revenue compared with only $63.4K in total Medicare revenue, indicating Medicaid revenue dominates its payer mix and overall business footprint. The provider’s NPI has been active since 2005-12-13 (~21 years ago), so this large Medicaid presence is supported by a long-tenured enrollment.
Revenue concentration is high on both payers but especially Medicare: the top three Medicare codes (G0483, 80307, G0481) account for 91.3% of the provider’s Medicare revenue, while the top three Medicaid codes (80307, G0483, G0480) account for 73.0% of its Medicaid revenue. This indicates the business is heavily dependent on a narrow set of drug-testing services for its billed volumes and receipts.
The code mix and descriptions show MEDTOX operates as a high-throughput clinical toxicology and laboratory services provider: dominant codes are large-panel definitive drug tests (G0483, G0481, G0480) and presumptive instrumented drug screens (80307), and the Medicaid file also shows substantial lead testing (83655) and basic hematology (85018). Together these codes reflect an operation focused on mass specimen processing for drug monitoring and public-health screening.
On Medicaid the provider is a clear in-state market leader for multiple codes: 80307 (450.8K claims, $15.3M revenue) ranks #1 of 101 providers in-state and is described as an "extreme outlier, far above typical state volume," while G0483 (125.1K claims, $10.3M) and G0480 (186.7K claims, $9M) both rank #1 in-state (100th percentile) and are described as notably above or extreme outlier volumes. Multiple other Medicaid codes (including 83655 and 85018) are also ranked #1 in-state and labeled extreme outliers, signaling that MEDTOX is a dominant statewide processor for many specimen types.
By contrast, MEDTOX’s Medicare competitive standing is modest nationally: its largest Medicare code G0483 (155 claims, $37.5K revenue) ranks #424 of 1063 providers nationally (60th percentile) and 80307 (215 claims, $12.9K revenue) ranks #1736 of 4760 providers nationally (63th percentile), characterizing the provider as a typical, unremarkable national participant rather than a national leader for these codes. The very small absolute Medicare revenue ($63.4K) reinforces that Medicare is not a primary channel for its services.
The Medicaid claim volumes underline the operational scale of specimen throughput: the three highest-volume Medicaid codes alone show 450.8K claims for 80307, 186.7K claims for G0480, and 125.1K claims for G0483, demonstrating sustained high-volume processing capacity. These claim counts, combined with the in-state #1 ranks, suggest MEDTOX has extensive specimen intake and reporting infrastructure concentrated on toxicology panels and targeted analyte testing.
High concentration in a few service lines creates business sensitivity to payer policy and pricing changes: with 91.3% of Medicare revenue coming from the top three Medicare codes and 73.0% of Medicaid revenue tied to the top three Medicaid codes, shifts in reimbursement, coding rules, or contracting for those specific toxicology panels would materially affect revenue performance. For payer or network analysts, these concentrations identify the specific codes to monitor for utilization or unit-price changes.
The provider’s long tenure (NPI enumerated 2005-12-13, ~21 years ago) paired with dominant in-state Medicaid rankings indicates an established operating presence in Minnesota’s Medicaid laboratory market, while its national Medicare ranks suggest it has not built a comparable national Medicare footprint. This asymmetric footprint is important when assessing negotiating leverage, referral sources, and the likely focus of operational investments.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 160 | $240 | $37.5K |
| 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. | 220 | $60 | $12.9K |
| 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… | 50 | $150 | $7.5K |
| 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… | 90 | $60 | $5.1K |
| 80165 | The lab analyst measures the amount of free valproic acid in the blood. Valproic acid is a drug that provider uses to treat certain types of seizures. | 20 | $10 | $230 |
| 80188 | The lab analyst performs the technical lab test to analyze a specimen to quantitate the amount of primidone present, which is an anticonvulsant medication. | 10 | $20 | $190 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 CPT/HCPCS codes.
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.
79 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 450,760 | $30 | $15.3M |
| 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… | 125,140 | $80 | $10.3M |
| 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… | 186,710 | $50 | $9M |
| 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… | 64,120 | $70 | $4.2M |
| 83655 | The lab analyst performs a test to measure the amount of lead in the patient specimen. A typical aim of the test is to check for lead exposure. | 562,460 | $10 | $3.9M |
| 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… | 32,990 | $90 | $2.9M |
| 80348 | The lab analyst measures the amount of or detects the presence of buprenorphine in a patient specimen. Buprenorphine is a drug used to treat opioid addiction, to control acute pain in individuals who… | 36,540 | $1 | $146.1K |
| 80359 | The lab analyst measures the amount of or detects the presence of methylenedioxyamphetamines in the patient specimen. | 32,780 | $1 | $131.1K |
| 80361 | The lab analyst measures the amount of or detects the presence of one or more opiates, narcotic analgesics that depress the central nervous system, in the specimen. | 32,010 | $1 | $128K |
| 80353 | The lab analyst measures the amount of or detects the presence of cocaine in the patient specimen. | 31,960 | $1 | $127.8K |
Showing 1–10 of 79
How this provider's Medicaid billing volume and revenue compare to other Minnesota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Minnesota median
79 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 1 | 10 | 3,220 | $110 | $2.2M |
| 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… | 2 | 10 | 2,200 | $120 | $1.3M |
| 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… | 1 | 10 | 1,590 | $100 | $1.2M |
| 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… | 1 | 30 | 340 | $60 | $890.4K |
| 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. | 1 | 100 | 510 | $40 | $560.8K |
| 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… | 91 | 120 | 650 | $50 | $225.2K |
| 80361 | The lab analyst measures the amount of or detects the presence of one or more opiates, narcotic analgesics that depress the central nervous system, in the specimen. | 1 | 10 | 17,770 | $1 | $69.2K |
| 80370 | The lab analyst measures the amount of or detects the presence of three or more skeletal muscle relaxants in the patient specimen. These drugs reduce the tone of skeletal muscles and thus alleviate… | 1 | 10 | 24,040 | $1 | $61.2K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 150 | 170 | 210 | $30 | $61K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 146 | 160 | 200 | $30 | $60.9K |
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Other providers in the same ZIP code as Medtox Laboratories, Inc, ranked by combined Medicare and Medicaid revenue.
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