Loading...
NPI 1679518971 · Hagerstown, MD · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Meritus Medical Laboratory LLC is a clinical medical laboratory provider located in Hagerstown, Maryland. This profile covers 288 Medicare and 184 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 | Meritus Medical Laboratory LLC |
| Address | 11110 Medical Campus Rd |
| City | Hagerstown |
| State | MD |
| ZIP | 21742 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | June 19, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $12.1M |
| Medicare | $3.4M |
Payer mix is Medicaid‑dominant: lifetime Medicaid revenue is $12.1M compared with total Medicare revenue of $3.4M, indicating the provider derives substantially more revenue from state programs than from Medicare. This profile is not single‑payer but heavily skewed toward Medicaid claim volume and payment.
Revenue concentration differs by payer: the top three Medicare codes account for 39.4% of Medicare revenue, driven by 36415, 80053, and 80061, while the top three Medicaid codes account for 54.0% of Medicaid revenue with U0003, 87801, and 80061 concentrated at the top. These precomputed shares show a moderate concentration of revenue in a small set of high-volume tests for Medicare and a higher concentration in a few codes for Medicaid.
Business/service-line: the code mix and volumes indicate a high-throughput clinical laboratory focused on routine phlebotomy and core chemistry/hematology panels plus significant infectious‑disease molecular testing. For Medicare, 36415 has 53K claims and $424.2K revenue (17.0% of Medicare revenue) and 80053 has 30.4K claims and $303.7K revenue (12.1%); for Medicaid, U0003 has 46K claims and $4.1M revenue (43.1% of Medicaid revenue), showing simultaneous emphasis on specimen collection, routine panels, and high-volume SARS‑CoV‑2 PCR.
National competitive standing on Medicare shows unusually high volumes for routine codes: 36415 ranks #69 of 86467 providers nationally (100th percentile; extreme outlier, far above typical national volume for this code) and 80053 ranks #96 of 26416 providers nationally (100th percentile; notably above typical national volume for this code). These ranks indicate the provider is an outlier nationally on basic collection and common chemistry testing volumes.
State competitive standing on Medicaid signals a leading regional role in COVID and multiplex testing: U0003 ranks #3 of 83 providers in-state (98th percentile) with 46K claims and $4.1M revenue, and 80053 ranks #2 of 124 providers in-state (99th percentile) with 50.4K claims and $453.9K revenue. Multiple top Medicaid codes (e.g., 87801 rank #2 of 25, 82306 rank #3 of 87) sit in high state percentiles, supporting characterization as a major in-state testing hub for high-volume assays.
Presence of specialty and proprietary assays alongside routine testing suggests a mixed service model: Medicaid shows use of PLA 0225U (531 claims, $185.9K revenue; ranks #1 of 2 in-state, 100th percentile) and high revenue for respiratory panels such as 87633 (1.3K claims, $442.5K revenue), while Medicare includes pathology and immunohistochemistry entries such as 88305 (2.8K claims, $72.9K revenue). This combination implies the lab offers both high-volume automated testing and selected higher‑complexity or proprietary assays.
Statistical outliers and notable specialty ranks are present across payers: besides 36415 being labeled an "extreme outlier," the provider also ranks #1 of 9 nationally on 86920 (386 claims, $24.7K revenue; 100th percentile; notably above typical national volume for this code) and holds top in-state positions on several Medicaid codes. These labels and ranks point to unusually concentrated operational scale for specific procedures like phlebotomy and certain specialized compatibility or molecular assays.
Tenure and operational inference: the NPI was enumerated on 2006-06-19 (~20 years ago), indicating long-standing registration. Combined with consistently high claim counts across both Medicare (e.g., tens of thousands of claims on key codes) and Medicaid (e.g., 46K U0003 claims, 50.4K 80053 claims), the data support an established, high-throughput laboratory footprint likely servicing broad clinical demand rather than a recent or niche entrant.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
288 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. | 53,030 | $10 | $424.2K |
| 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. | 30,370 | $10 | $303.7K |
| 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. | 19,890 | $10 | $258.5K |
| 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… | 28,200 | $10 | $225.6K |
| 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… | 13,190 | $20 | $211K |
| 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… | 5,770 | $30 | $167.2K |
| 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).… | 16,740 | $10 | $150.6K |
| 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. | 1,920 | $40 | $76.9K |
| 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… | 2,800 | $30 | $72.9K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 8,660 | $10 | $69.3K |
Showing 1–10 of 288
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 288 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
288 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87506 | 4 | 10 | 210 | $260 | $96.7K |
| 88305 | 31 | 270 | 490 | $40 | $61.4K |
| 87481 | 29 | 60 | 160 | $30 | $48.7K |
| 87536 | 3 | 10 | 110 | $80 | $48.1K |
| 82024 | 2 | 10 | 150 | $40 | $46.6K |
| 87799 | 23 | 30 | 140 | $40 | $42.1K |
| 87186 | 6 | 20 | 670 | $10 | $39.6K |
| 83970 | 2 | 30 | 30 | $40 | $36.3K |
| 87801 | 12 | 20 | 140 | $70 | $34.7K |
| 88313 | 123 | 140 | 70 | $60 | $29.4K |
Showing 1–10 of 288
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.
184 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… | 46,040 | $90 | $4.1M |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 9,070 | $60 | $571.1K |
| 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. | 41,720 | $10 | $458.9K |
| 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. | 50,440 | $10 | $453.9K |
| 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… | 20,280 | $20 | $446.2K |
| 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… | 1,250 | $350 | $442.5K |
| 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… | 30,640 | $10 | $398.3K |
| 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… | 52,680 | $10 | $316.1K |
| 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).… | 35,790 | $10 | $286.3K |
| 0225U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0225U for the… | 530 | $350 | $185.8K |
Showing 1–10 of 184
How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland median
184 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… | 3 | 80 | 500 | $70 | $691.2K |
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 6 | 10 | 5,010 | $80 | $668.2K |
| 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… | 32 | 60 | 780 | $80 | $613.1K |
| 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… | 4 | 10 | 180 | $230 | $388.6K |
| 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. | 54 | 160 | 980 | $50 | $387.6K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 13 | 50 | 660 | $30 | $289.2K |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 3 | 10 | 200 | $40 | $289K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 14 | 50 | 640 | $30 | $284.4K |
| 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… | 2 | 10 | 190 | $240 | $247.5K |
| 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… | 5 | 30 | 550 | $20 | $244.7K |
Showing 1–10 of 184
Other providers in the same ZIP code as Meritus Medical Laboratory LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Brook Lane Behavioral Services, Inc. | MD | Mental Health Clinic/Center (Including Community Mental Health Center) | $0 | $14.5M |
| Meritus Urgent Care, LLC | MD | Urgent Care Clinic/Center | $0 | $4.9M |
| William Su | MD | Vascular Surgery Physician | $1.4M | $0 |
| Syed Mahmood | MD | Medical Oncology Physician | $1M | $0 |
| Sarim Mir | MD | Neurology Physician | $801.3K | $0 |
| Meridian Surgery Center LLC | MD | Ambulatory Surgical Clinic/Center | $614.4K | $0 |
| Hagerstown Surgery Center,llc | MD | Ambulatory Surgical Clinic/Center | $559K | $28.4K |
| Thomas Gilbert | MD | Emergency Medicine Physician | $556.7K | $0 |
| Nina Gordon | MD | Diagnostic Radiology Physician | $496.6K | $0 |
| Joseph Holobinko | MD | Orthopaedic Surgery Physician | $481.6K | $0 |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.