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NPI 1811524572 · Norfolk, VA · Clinical Medical Laboratory
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Sentara Reference Lab Solutions, LLC is a clinical medical laboratory provider located in Norfolk, Virginia. This profile covers 437 Medicare and 314 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 | Sentara Reference Lab Solutions, LLC |
| Address | 600 Gresham Dr |
| City | Norfolk |
| State | VA |
| ZIP | 23507 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | March 24, 2020 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $12.9M |
| Medicaid | $4.7M |
This entity is a high-volume clinical medical laboratory: its Medicare billing is $12.9M while Medicaid billing is $4.7M, so Medicare is the larger revenue source by scale and the provider operates across both payers rather than being single-payer. The presence of large claim counts for routine panels and phlebotomy codes (for example, 80053 with 123.1K claims and 36415 with 93K claims on Medicare) points to a centralized, high-throughput specimen processing operation serving ambulatory and screening workflows.
Medicare revenue is concentrated in a small set of routine diagnostic panels: the precomputed top 3 Medicare codes account for 38.0% of Medicare revenue, and those top codes include 80061 (14.0% of Medicare revenue), 80053 (12.6%), and 84443 (11.5%). These three codes are all routine chemistry/endocrine assays (lipid panel, comprehensive metabolic panel, and TSH), indicating the lab’s core service line is high-volume clinical chemistry and endocrine testing.
On Medicare this provider is a national volume leader for many routine tests: multiple top Medicare codes are recorded as 100th-percentile “extreme outlier” volumes nationally (examples include 80061 rank #31 of 21671, 80053 rank #38 of 26416, 84443 rank #34 of 19722). That ranking pattern signals a dominant national presence for common laboratory panels and monitoring tests rather than a modest local participant.
Medicaid billing shows concentrated state-level dominance in several screening and STI panels: the precomputed top 3 Medicaid codes account for 23.1% of Medicaid revenue, led by U0004 (8.5% of Medicaid revenue), 80050 (7.3%), and 87491 (7.3%). The Medicaid code mix emphasizes high-volume population screening and infectious-disease NAATs (including COVID PCR and STI testing), consistent with a lab that handles public-health and preventive testing at scale.
State competitive standing for Medicaid is particularly strong: the provider ranks #1 in-state for multiple high-revenue Medicaid codes (for example 80050 rank #1 of 66, 80061 rank #1 of 224, 83036 rank #1 of 329, 82306 rank #1 of 138) and several other Medicaid codes are listed as extreme outlier or near-extreme in-state. This indicates the lab is a leading Medicaid testing destination in Virginia for routine panels, vitamin D, A1C and many infectious disease assays.
Although the core business is high-volume routine testing, the practice also bills higher-complexity and specialty codes at smaller scale: Medicare shows 88377 with $104.5K revenue (1.1% of Medicare revenue, rank #57 of 616, labeled typical), while Medicaid shows 81220 with $91.9K revenue and 87536 with $92.7K revenue (each described as typical or unremarkable in-state). Those entries show capability in pathology/molecular testing but at a modest proportion of total revenue compared with routine panels.
The provider’s code-level patterns show operational breadth across specimen collection and automated analyzers: high Medicare counts for phlebotomy 36415 (93K claims, $743.8K revenue) alongside many automated chemistry and hematology panel codes (80053, 80048, 85025) point to integrated sample collection plus lab-run testing rather than solely referral-only molecular work. Combined with Medicaid volumes for NAAT STI codes (87491, 87591, 87661) and COVID testing U0004, the facility appears set up for both general clinical lab services and high-throughput infectious disease testing.
SENTARA REFERENCE LAB SOLUTIONS, LLC has an NPI enumeration date of 2020-03-24 (~6 years ago) and already reports extreme and near-extreme volumes on many measures; given that tenure, its current Medicare national outlier status and multiple #1 in-state Medicaid rankings indicate it scaled quickly to a leadership position in routine diagnostic testing within a relatively short operational window.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
437 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 105,110 | $10 | $1.4M |
| 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. | 123,150 | $10 | $1.2M |
| 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… | 70,340 | $20 | $1.1M |
| 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… | 33,320 | $30 | $966.3K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 92,970 | $10 | $743.8K |
| 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).… | 77,350 | $10 | $696.2K |
| 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… | 86,060 | $10 | $688.4K |
| 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. | 10,430 | $40 | $417.3K |
| 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… | 44,790 | $10 | $358.3K |
| 85027 | The lab analyst performs a blood count on the red and white blood cells and platelets also known as thrombocytes. He also determines the hemoglobin, typically by spectrophotometry, and the… | 44,590 | $10 | $267.5K |
Showing 1–10 of 437
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 437 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
437 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| P9603 | 5 | 10 | 8,090 | $1 | $403.7K |
| 87798 | 29 | 30 | 690 | $30 | $159.2K |
| 88121 | 5 | 10 | 250 | $340 | $158.9K |
| 88305 | 25 | 250 | 760 | $40 | $55.8K |
| 88185 | 4 | 60 | 620 | $20 | $34.3K |
| 86832 | 1 | 10 | 110 | $310 | $33.7K |
| 86833 | 1 | 10 | 110 | $310 | $33.5K |
| 88237 | 1 | 10 | 180 | $140 | $25.1K |
| 86235 | 1 | 10 | 460 | $20 | $23.8K |
| G0480 | 10 | 10 | 140 | $110 | $23.5K |
Showing 1–10 of 437
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
314 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by… | 7,040 | $40 | $274.7K |
| 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… | 47,500 | $10 | $237.5K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 78,420 | $1 | $235.3K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 78,380 | $1 | $235.1K |
| 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. | 115,100 | $1 | $230.2K |
| 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. | 109,090 | $1 | $218.2K |
| 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… | 54,010 | $1 | $216.1K |
| 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).… | 96,950 | $1 | $193.9K |
| 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… | 51,580 | $1 | $154.8K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 65,550 | $1 | $131.1K |
Showing 1–10 of 314
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
314 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 | 10 | 290 | $550 | $797.9K |
| 87799 | The lab analyst performs a test to quantify infection with an infectious agent, not otherwise specified in another code, using a nucleic acid probe technique. Use this code if you know the laboratory… | 10 | 10 | 1,000 | $30 | $502.2K |
| 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. | 36 | 170 | 3,790 | $40 | $415.2K |
| 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 | 900 | $190 | $390.3K |
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 3 | 10 | 5,750 | $50 | $243.5K |
| 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… | 57 | 100 | 2,220 | $40 | $214.2K |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 2 | 20 | 350 | $30 | $170.5K |
| 87902 | The lab analyst performs the technical lab test to analyze the specific genotype by nucleic acid of a specimen containing hepatitis C virus. | 5 | 10 | 370 | $70 | $158K |
| 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… | 38 | 160 | 1,900 | $30 | $129.8K |
| 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… | 5 | 10 | 1,120 | $70 | $121.7K |
Showing 1–10 of 314
Other providers in the same ZIP code as Sentara Reference Lab Solutions, LLC, ranked by combined Medicare and Medicaid revenue.
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