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NPI 1740460583 · San Juan, PR · Clinical Medical Laboratory
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Hato Rey Pathology Associates Inc is a clinical medical laboratory provider located in San Juan, Puerto Rico. This profile covers 32 Medicare and 88 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 | Hato Rey Pathology Associates Inc |
| Address | 300 -302 Ave Domenech |
| City | San Juan |
| State | PR |
| ZIP | 00918 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | November 9, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $42M |
| Medicare | $58.5K |
Payer mix is heavily skewed toward Medicaid: the provider reports $42M in total Medicaid revenue versus only $58.5K in total Medicare revenue, meaning its operations are effectively Medicaid‑driven rather than Medicare‑driven. This large disparity implies the bulk of specimen volume, billing relationships, and operating scale are tied to state Medicaid contracts and referral sources.
Medicare revenue is modest and concentrated: the top three Medicare codes account for 48.1% of this provider's Medicare revenue, led by 87624 ($15.3K), 88237 ($8.2K), and 81513 ($4.1K). The Medicare code mix is weighted toward molecular and specialized laboratory testing (HPV typing, marrow culture/analysis, and algorithmic BV testing), but the absolute Medicare dollars are small relative to Medicaid.
Medicaid revenue is concentrated in high‑value anatomic pathology and molecular testing: the top three Medicaid codes account for 44.4% of Medicaid revenue, led by 88305 ($11.5M), 87624 ($3.1M), and 88312 ($3M). This indicates surgical pathology interpretations and specialized stain/technical services are the primary revenue drivers for the provider under Medicaid.
The code mix points to a full‑service anatomic pathology and cytology operation with significant ancillary molecular/flow cytometry capabilities: dominant Medicaid codes include 88305 (surgical pathology), 88312 (special stains), 88141/88142/88175 (cytopathology professional and technical components), and high volumes of STD molecular testing (87491, 87591, 87624). The presence of codes such as 88185, 88189, and 88341 further signals routine use of flow cytometry and immunohistochemistry workflows.
State competitive standing is strong and concentrated: multiple Medicaid codes rank at the top in‑state — for example, 88305 is #1 of 32 providers in‑state (100th percentile; extreme outlier, far above typical state volume), 88312 is #1 of 25 (100th percentile; extreme outlier, far above typical state volume), and both 87491 and 87591 are #1 in large provider pools (100th percentile; extreme outlier, far above typical state volume). These rankings characterize the provider as a dominant statewide source for surgical pathology, cytology, and STD NAAT testing.
Nationally on Medicare the provider is a modest participant: its highest‑revenue Medicare code 87624 ranks #83 of 475 (82th percentile; typical, unremarkable volume), 88237 ranks #48 of 107 (56th percentile; typical, unremarkable volume), and 81513 ranks #80 of 105 (21th percentile; typical, unremarkable volume). Those percentiles indicate routine national volume for these services rather than a national leadership position.
Tenure supports an established in‑state footprint: the NPI was enumerated on 2007-11-09 (~19 years ago), consistent with a long‑standing lab/pathology practice that has likely developed entrenched Medicaid referral relationships and capacity to support large surgical and cytology volumes.
The provider’s Medicaid concentration and numerous “extreme outlier” and “notably above typical” in‑state labels create both leverage and exposure: dominant positions in codes such as 88305, 88312, 87491, and 87591 suggest strong negotiating or referral advantages within the state, but also imply material sensitivity to state Medicaid policy, contract changes, or reimbursement pressure for those high‑volume codes.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
32 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 450 | $30 | $15.3K |
| 88237 | The lab analyst performs a procedure to grow a culture of cells from bone marrow or blood in a neoplastic disorder. | 60 | $140 | $8.2K |
| 81513 | The lab analyst performs the technical lab test on a vaginal fluid specimen for quantitative real–time amplification of RNA markers for three bacterial species listed in the code descriptor, and… | 30 | $140 | $4.1K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 100 | $30 | $3.3K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 100 | $30 | $3.3K |
| 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… | 20 | $160 | $3.2K |
| 88264 | The analyst performs a chromosome analysis and analyzes 20 to 25 cells. The analysis includes counting the number of chromosomes in each cell and preparing a karyotype for each cell examined. | 20 | $140 | $2.8K |
| 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… | 30 | $70 | $2.1K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 60 | $30 | $2K |
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 40 | $40 | $1.4K |
Showing 1–10 of 32
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 32 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
88 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 126,280 | $90 | $11.5M |
| 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. | 78,410 | $40 | $3.1M |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 24,360 | $120 | $3M |
| 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… | 7,100 | $410 | $2.9M |
| 88307 | The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 9,640 | $240 | $2.3M |
| 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… | 6,690 | $340 | $2.3M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 57,560 | $30 | $2M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 57,570 | $30 | $1.9M |
| 88142 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 60,110 | $30 | $1.6M |
| 88173 | The lab analyst performs the technical lab test to analyze a cytopathology specimen from a fine needle aspirate and then interprets and reports the results. | 8,240 | $150 | $1.2M |
Showing 1–10 of 88
How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Puerto Rico median
88 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 1 | 30 | 4,250 | $80 | $1.3M |
| 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… | 2 | 10 | 7,100 | $80 | $1.2M |
| 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… | 3 | 10 | 1,420 | $300 | $1.2M |
| 88365 | The lab analyst applies an initial in situ hybridization single probe stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a… | 4 | 10 | 290 | $90 | $871K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 3 | 10 | 4,190 | $30 | $655.7K |
| 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. | 2 | 30 | 910 | $40 | $638.8K |
| 88307 | The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 2 | 20 | 1,210 | $190 | $535.5K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 1 | 30 | 1,210 | $150 | $530.3K |
| 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 | 10 | 5,330 | $40 | $504.5K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 4 | 20 | 2,030 | $80 | $485.9K |
Showing 1–10 of 88
Other providers in the same ZIP code as Hato Rey Pathology Associates Inc, ranked by combined Medicare and Medicaid revenue.
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