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NPI 1790721538 · Irving, TX · Clinical Medical Laboratory
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Quest Diagnostics Clinical Laboratories Inc is a clinical medical laboratory provider located in Irving, Texas. This profile covers 570 Medicare and 593 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 | Quest Diagnostics Clinical Laboratories Inc |
| Address | 4770 Regent Blvd |
| City | Irving |
| State | TX |
| ZIP | 75063 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | June 21, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $276.8M |
| Medicare | $46.7M |
QUEST DIAGNOSTICS CLINICAL LABORATORIES INC is operating as a high-volume clinical diagnostic laboratory: its Medicare billing is concentrated in routine phlebotomy and common lab panels (examples include 36415, 80053 and 84443) while its Medicaid billing shows massive volume in molecular infectious-disease testing (notably U0003). The top 3 Medicare codes by revenue account for 33.6% of this provider's total Medicare revenue and the top 3 Medicaid codes by revenue account for 38.5% of this provider's total Medicaid revenue, underlining a business model built around a relatively small set of high-throughput tests.
The provider’s payer mix is heavily weighted to Medicaid in absolute scale: reported lifetime Medicaid revenue is $276.8M compared with $46.7M in Medicare, indicating Medicaid payments drive the majority of its billed volume and revenue. This magnitude difference signals the operation is effectively Medicaid-dominant in revenue terms, though Medicare remains a meaningful secondary channel for routine testing and outpatient panels.
Medicare code-level activity shows national dominance on many common lab services: multiple high-revenue Medicare codes (for example, 36415 at $4M, 80053 at $3.3M and 84443 at $2.8M) are reported as 100th percentile and labeled “extreme outlier,” with ranks such as #11, #17 and #18 nationally. Those percentile labels and ranks indicate this provider bills far above the typical national volume for core specimen-collection and chemistry/endocrine tests, consistent with a national-scale laboratory footprint for routine Medicare services.
State-level Medicaid data reinforces a dominant in-state position for key services: U0003 ($48.4M) and many other top Medicaid codes (including 80050 at $13.6M, 87491 at $13.4M and 87591 at $13.3M) rank #1 in-state and are described as “extreme outlier.” These state rankings show the provider is the leading Medicaid supplier in Texas for high-throughput COVID PCR, general panels and NAAT-based STI testing, indicating market leadership for molecular and screening services within the state.
The provider’s product mix spans routine automated testing and specialized molecular/genomic services: high volumes in codes like 80061, 80050, 80053 and 85025 reflect large-scale chemistry and hematology panels, while large Medicaid revenues for U0003, U0005, 81420 and numerous NAAT codes (87491, 87591, 87661) show substantial capacity in high-throughput molecular diagnostics and targeted genomic assays. This combination suggests an integrated lab operation handling both specimen collection/processing and complex molecular workflows at scale.
Drug- and specialty-testing represent a material secondary line of business: Medicare entries such as G0480 ($1.4M) and G0482 ($434.8K) are reported as very high-percentile volumes (99th and 98th percentiles respectively) and Medicaid G0480 ($3.7M) ranks #1 in-state, while presumptive screens (80307) and definitive testing also appear prominently. The presence of both presumptive and definitive toxicology codes at extreme percentiles indicates the lab services a broad customer base including clinical toxicology/forensic workflows.
The provider displays persistent, long-tenured presence in the Medicare/Medicaid systems: the NPI was enumerated on 2006-06-21 (~20 years ago), consistent with an established, multi-decade laboratory operation that has scaled into leadership positions across multiple test categories. That tenure supports the data pattern of extensive national Medicare volumes for routine tests alongside dominant state Medicaid volumes for molecular and high-throughput panels.
Concentration of revenue in a limited set of tests is notable and operationally meaningful: the precomputed shares (top 3 Medicare codes = 33.6% of Medicare revenue; top 3 Medicaid codes = 38.5% of Medicaid revenue) show a sizable portion of billing is driven by a handful of services—examples include specimen collection and common panels on Medicare (36415, 80053, 84443) and high-volume molecular testing on Medicaid (U0003, 80050, 87491). For payers and contracting analysts, these concentrations identify the specific service lines (phlebotomy/automated panels and molecular/NAAT testing) that will materially affect rate negotiations and utilization management strategies.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
570 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. | 501,230 | $10 | $4M |
| 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. | 333,450 | $10 | $3.3M |
| 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… | 177,590 | $20 | $2.8M |
| 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. | 212,170 | $10 | $2.8M |
| 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… | 77,610 | $30 | $2.3M |
| 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… | 280,690 | $10 | $2.2M |
| 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. | 38,950 | $40 | $1.6M |
| 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).… | 153,490 | $10 | $1.5M |
| 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… | 12,280 | $110 | $1.4M |
| 86235 | The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,… | 47,050 | $20 | $846.9K |
Showing 1–10 of 570
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 570 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
570 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 87798 | 215 | 300 | 790 | $30 | $265.1K |
| 81450 | 4 | 10 | 30 | $700 | $140K |
| 87900 | 6 | 10 | 50 | $130 | $111.5K |
| 81339 | 10 | 20 | 280 | $180 | $100.3K |
| 81279 | 10 | 20 | 270 | $180 | $86.8K |
| 87801 | 20 | 120 | 170 | $70 | $86.5K |
| G0483 | 75 | 170 | 150 | $240 | $84.9K |
| 83876 | 2 | 10 | 610 | $50 | $80.1K |
| 86003 | 1 | 10 | 8,740 | $10 | $78.5K |
| 87536 | 1 | 10 | 560 | $80 | $75.8K |
Showing 1–10 of 570
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.
593 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… | 691,970 | $70 | $48.4M |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 618,020 | $20 | $13.6M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 703,320 | $20 | $13.4M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 699,860 | $20 | $13.3M |
| 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. | 1,428,500 | $10 | $8.6M |
| 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,… | 406,240 | $20 | $8.5M |
| 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… | 573,630 | $10 | $7.5M |
| 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. | 237,980 | $30 | $7.1M |
| 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… | 550,070 | $10 | $6.6M |
| 81420 | The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,… | 18,820 | $340 | $6.4M |
Showing 1–10 of 593
How this provider's Medicaid billing volume and revenue compare to other Texas providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Texas median
593 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81420 | The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,… | 3 | 20 | 950 | $300 | $3.2M |
| 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… | 2 | 20 | 180 | $200 | $923K |
| 80081 | The lab analyst performs an obstetric panel; this panel must include tests for a complete blood count with differential, a hepatitis B surface antigen test, a single–result test for HIV–1 antigens… | 1 | 20 | 250 | $40 | $821.3K |
| 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… | 1 | 340 | 400 | $50 | $553.5K |
| 81443 | The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least 15 genes, such as the 20 gene examples listed in the code descriptor. The… | 2 | 10 | 1,040 | $280 | $552.5K |
| 81229 | The lab analyst performs the technical lab test using comparative genomic hybridization (CGH) microarray, also referred to as chromosomal microarray (CMA) or molecular karyotype performed by… | 1 | 10 | 1,150 | $380 | $434.7K |
| 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… | 1 | 30 | 410 | $70 | $363.5K |
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 3 | 160 | 200 | $110 | $323.8K |
| 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… | 5 | 160 | 200 | $280 | $321.8K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 1 | 150 | 170 | $30 | $302.9K |
Showing 1–10 of 593
Other providers in the same ZIP code as Quest Diagnostics Clinical Laboratories Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Accredo Health Group Inc | TX | Pharmacy | $0 | $27.7M |
| Andrew Lee | TX | Radiation Oncology Physician | $2.2M | $0 |
| Jared Sturgeon | TX | Radiation Oncology Physician | $2.1M | $0 |
| Firstox Laboratories, LLC | TX | Clinical Medical Laboratory | $241K | $1.3M |
| Victor Mangona | TX | Radiation Oncology Physician | $1.6M | $0 |
| Carenexa, LLC | TX | Clinical Medical Laboratory | $1.1M | $15K |
| David Hull | TX | Anatomic Pathology & Clinical Pathology Physician | $1.1M | $10.1K |
| Biostat Imaging | TX | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | $852.9K | $179.1K |
| Daniel Suez | TX | Allergy & Immunology Physician | $697.4K | $0 |
| Thomas Salmon | TX | Neurology Physician | $591.8K | $0 |
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