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NPI 1750373908 · Hamilton, NJ · Clinical Medical Laboratory
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Medical Diagnostic Laboratories,llc is a clinical medical laboratory provider located in Hamilton, New Jersey. This profile covers 69 Medicare and 91 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 | Medical Diagnostic Laboratories,llc |
| Address | 2439 Kuser Rd |
| City | Hamilton |
| State | NJ |
| ZIP | 08690 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | August 15, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $81M |
| Medicare | $5.6M |
Payer mix is heavily skewed toward Medicaid: lifetime Medicaid revenue is $81M compared with $5.6M in Medicare, indicating the organization operates primarily as a Medicaid-focused laboratory rather than a balanced Medicare/Medicaid provider. This scale difference means Medicaid reimbursement dynamics and in‑state contracts will materially shape the business more than national Medicare trends.
The provider’s service mix is dominated by high-volume molecular amplified probe testing and related cytology services, as evidenced by large revenues tied to codes like 87798, 87481, 87491, 87591 and 88175. These codes correspond to nucleic acid amplification tests for a range of infectious agents (including multiple STI targets) and automated thin‑layer cervical/vaginal cytology processing, indicating an operational emphasis on centralized, high-throughput diagnostic testing for sexual health and infection surveillance.
Revenue concentration on Medicare is extreme at the code level: the top 3 Medicare codes account for 72.0% of the provider’s Medicare revenue, with 87798 contributing $2.2M (42.1% of Medicare revenue) and 87481 contributing $1.3M (24.9%). Both codes rank well above typical national volumes (87481 is an extreme outlier at the 100th percentile and 87798 ranks in the 98th percentile), which indicates the provider’s Medicare business is tightly concentrated in a small set of high-volume NAAT procedures.
Medicaid revenue is also concentrated but distributed across a slightly broader mix: the top 3 Medicaid codes account for 53.2% of Medicaid revenue, led by 87798 at $19.5M (24.3%), 87481 at $13M (16.2%), and 87491 at $10.2M (12.7%). Several of these codes are ranked at the top in‑state (87798 and 87481 are #1 in‑state and labeled extreme outliers), signaling that a majority of Medicaid income is driven by high-volume infectious-agent NAAT testing within the state.
Competitive standing differs by payer: for Medicare the provider shows national outlier behavior on select NAAT codes (87481 is #6 nationally and an extreme outlier; 87511 is #2 nationally and a 99th‑percentile outlier), meaning it is a major national contributor for certain test types despite modest total Medicare revenue. For Medicaid the provider is a clear in‑state market leader on multiple top codes (87798, 87481, 87511, 87653 and 87640 all rank #1 in‑state with extreme outlier designations), indicating dominant statewide volume for core assays.
Operational footprint includes substantial cytology and pathology technical work in addition to molecular testing: 88175 appears among top Medicare codes with $119K and ranks #3 nationally (99th percentile), and 88141 shows up in Medicaid with $208.3K, implying the lab performs automated thin‑layer specimen preparation and both technical and professional cytology services. The presence of 88305, 88341 and 88342 in both payer lists further supports a mixed service-line that includes surgical pathology support, not only infectious-disease molecular diagnostics.
The provider carried a meaningful COVID testing line in Medicaid claims: U0003 generated $5.3M (6.6% of Medicaid revenue) and ranks #15 in‑state (89th percentile), indicating the lab adopted high-throughput SARS‑CoV‑2 amplified probe testing during the pandemic and captured sizable Medicaid volume for that service. This demonstrates capacity for scalable, high-throughput molecular workflows beyond routine STI panels.
Tenure and likely business model implications: the NPI was enumerated 2005-08-15 (~21 years ago), reflecting long-standing operation. Combined with repeated extreme outlier rankings and #1 in‑state positions across multiple NAAT codes, the pattern is consistent with a well-established centralized lab that processes large referral volumes across the state and specializes in high-throughput molecular and cytology testing rather than low-volume, diversified outpatient services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
69 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… | 64,930 | $30 | $2.2M |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 38,470 | $30 | $1.3M |
| 87511 | The lab analyst performs a test for Gardnerella vaginalis using amplified nucleic acid probe technique. Gardnerella vaginalis, typically causes bacterial vaginosis, an infection of the vagina that… | 7,700 | $30 | $261.8K |
| 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,… | 5,080 | $30 | $172.9K |
| 87640 | The lab analyst performs the technical lab test to look for Staphylococcus aureus nucleic acid using an amplified probe technique. | 3,970 | $30 | $135K |
| 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. | 3,950 | $30 | $134.4K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 3,600 | $30 | $122.5K |
| 88175 | 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… | 4,580 | $30 | $119K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 3,480 | $30 | $118.3K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 3,440 | $30 | $116.8K |
Showing 1–10 of 69
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 69 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
69 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81307 | 7 | 10 | 910 | $660 | $635.4K |
| 81317 | 9 | 10 | 60 | $660 | $511.5K |
| 81298 | 9 | 10 | 60 | $630 | $489.5K |
| 87798 | 1 | 40 | 1,760 | $30 | $284.3K |
| 81201 | 7 | 10 | 30 | $760 | $193.4K |
| 81226 | 4 | 10 | 50 | $440 | $133.4K |
| U0003 | 34 | 80 | 110 | $70 | $101.7K |
| 81225 | 3 | 10 | 30 | $290 | $94.1K |
| 86617 | 4 | 20 | 250 | $20 | $73.7K |
| 87591 | 4 | 10 | 140 | $30 | $73K |
Showing 1–10 of 69
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.
91 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… | 1,144,640 | $20 | $19.5M |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 811,500 | $20 | $13M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 509,070 | $20 | $10.2M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 502,570 | $20 | $7.5M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 453,790 | $20 | $6.8M |
| 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… | 79,670 | $70 | $5.3M |
| 87511 | The lab analyst performs a test for Gardnerella vaginalis using amplified nucleic acid probe technique. Gardnerella vaginalis, typically causes bacterial vaginosis, an infection of the vagina that… | 289,130 | $20 | $4.3M |
| 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,… | 198,940 | $10 | $2.8M |
| 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. | 169,570 | $10 | $2M |
| 87529 | The lab analyst performs a test for Herpes simplex virus, HSV, using amplified nucleic acid probe technique. HSV causes clusters of blisters, or vesicles, on different parts of the body and spreads… | 96,600 | $20 | $1.7M |
Showing 1–10 of 91
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
91 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… | 15 | 130 | 3,180 | $60 | $4.2M |
| 88175 | 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… | 4 | 20 | 750 | $10 | $1.3M |
| 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… | 8 | 30 | 210 | $200 | $1.3M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 4 | 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. | 4 | 120 | 940 | $20 | $957.4K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 4 | 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,… | 33 | 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… | 1 | 90 | 630 | $30 | $806.2K |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 5 | 30 | 630 | $20 | $687.4K |
| 87512 | The lab analyst performs a test to quantify infection with Gardnerella vaginalis using nucleic acid probe technique. Gardnerella vaginalis, typically causes bacterial vaginosis, an infection of the… | 4 | 10 | 390 | $20 | $680.2K |
Showing 1–10 of 91
Other providers in the same ZIP code as Medical Diagnostic Laboratories,llc, ranked by combined Medicare and Medicaid revenue.
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