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NPI 1770889891 · Charlottesville, VA · Clinical Medical Laboratory
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University Pathology Associates, Plc is a clinical medical laboratory provider located in Charlottesville, Virginia. This profile covers 13 Medicare and 7 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 | University Pathology Associates, Plc |
| Address | 2331 Seminole Ln Ste 102 |
| City | Charlottesville |
| State | VA |
| ZIP | 22901 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | February 7, 2011 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.8M |
| Medicaid | $715.7K |
UNIVERSITY PATHOLOGY ASSOCIATES, PLC is classified as a Clinical Medical Laboratory and its billing mix is dominated by surgical pathology and immunohistochemistry workflows. The top Medicare and Medicaid codes (88305, 88342, 88341, and 88312) are all pathology service codes—88305 represents level IV surgical pathology while 88342 and 88341 represent initial and additional antibody stains—indicating the practice operates a high-volume anatomic pathology/IHC service line with additional special stains and ancillary testing on the side.
Medicare revenue at this provider is highly concentrated: the precomputed top-3 Medicare codes account for 89.4% of total Medicare revenue. Those three codes are 88305 ($1.8M, 64.7% of Medicare revenue), 88342 ($348K, 12.4%), and 88341 ($341.9K, 12.2%), which signals a heavy dependence on a small set of high-volume pathology procedures for Medicare income.
On Medicare competitive standing, the provider is a national outlier for multiple top services: 88305 ranks #33 of 14580 providers nationally (100th percentile; extreme outlier, far above typical national volume), and both 88342 and 88341 also rank in the 100th percentile as extreme outliers. Additionally, 88304 ranks #91 of 8796 (99th percentile; notably above typical national volume), which together indicate this lab performs far more of these pathology procedures than a typical U.S. peer and is a major national volume center for surgical pathology and IHC.
Medicaid revenue is likewise concentrated in a few pathology codes: the precomputed top-3 Medicaid codes account for 92.1% of total Medicaid revenue. The top Medicaid codes are 88305 ($468.6K, 65.0% of Medicaid revenue), 88312 ($112.8K, 15.7%), and 88342 ($81.9K, 11.4%), showing the same core pathology/IHC services drive Medicaid activity.
Within the state Medicaid market the provider appears as a solid regional participant rather than a statewide dominant player: 88305 ranks #22 of 158 in-state (87th percentile; typical, unremarkable volume), 88312 ranks #9 of 42 (80th percentile; typical, unremarkable volume), and 88342 ranks #21 of 85 (76th percentile; typical, unremarkable volume). These ranks indicate above-average in-state activity but not the extreme national volumes seen on the Medicare side.
Payer mix is Medicare-weighted in scale: reported lifetime Medicare revenue is $2.8M versus Medicaid revenue of $715.7K, so Medicare is the larger source of billed revenue while Medicaid represents a meaningful but smaller portion of the practice’s payer mix. This suggests strategic exposure to the Medicare beneficiary population and a secondary but material Medicaid presence.
The provider has an established operating tenure with NPI enumeration on 2011-02-07 (~15 years ago), consistent with the development of concentrated specialty capabilities and the ability to generate sustained, high-volume surgical pathology and IHC billing over time.
There is a reporting anomaly in the Medicaid top-25 list: G9785 shows 278 claims with $0 avg paid/claim and $0 revenue and ranks #1 of 1 in-state (0th percentile; no state peer volume comparison available). This unusual zero-paid entry likely reflects a non-reimbursed administrative or reporting code rather than a revenue-generating service and should be interpreted cautiously in payer/provider analyses.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 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… | 34,160 | $50 | $1.8M |
| 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,… | 4,520 | $80 | $348K |
| 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… | 5,180 | $70 | $341.9K |
| 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… | 1,640 | $90 | $141.3K |
| 88350 | The analyst performs an immunofluorescent study using a single antibody stain procedure to detect autoimmune disease or an infectious organism in a tissue or cellular sample. Code +88350 describes… | 400 | $90 | $36.4K |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 550 | $60 | $34.3K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 650 | $30 | $20.7K |
| 88321 | A qualified provider, typically a pathologist, provides consultation and a report on slides prepared elsewhere. A unit of service is the surgical case regardless of the number of slides received. | 270 | $70 | $19.4K |
| 88323 | A qualified provider, typically a pathologist, provides consultation and a report on referred material, such as a tissue block, and prepares and stains slides. A unit of service is the surgical case… | 140 | $90 | $12.5K |
| 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… | 90 | $140 | $12.5K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 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.
7 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… | 9,970 | $50 | $468.6K |
| 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… | 1,310 | $90 | $112.8K |
| 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,… | 1,520 | $50 | $81.9K |
| 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… | 450 | $80 | $38.1K |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 180 | $60 | $10.2K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 260 | $30 | $8.8K |
| G9785 | Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) sent from the pathologist/ dermatopathologist to the biopsying clinician… | 280 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Virginia median
7 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… | 22 | 160 | 1,900 | $30 | $129.8K |
| 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… | 10 | 40 | 150 | $30 | $16.8K |
| 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,… | 21 | 90 | 350 | $10 | $14.8K |
| 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… | 9 | 40 | 160 | $20 | $12.1K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 52 | 90 | 380 | $10 | $5.9K |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 13 | 30 | 160 | $10 | $3.8K |
| G9785 | Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) sent from the pathologist/ dermatopathologist to the biopsying clinician… | 1 | 10 | 280 | $0 | $0 |
Other providers in the same ZIP code as University Pathology Associates, Plc, ranked by combined Medicare and Medicaid revenue.
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