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NPI 1841962289 · Albuquerque, NM · Clinical Medical Laboratory
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Tricore Inc. is a clinical medical laboratory provider located in Albuquerque, New Mexico. This profile covers 389 Medicare and 310 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 | Tricore Inc. |
| Address | 1001 Woodward Pl Ne |
| City | Albuquerque |
| State | NM |
| ZIP | 87102 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | October 4, 2021 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $35.8M |
| Medicare | $7M |
Payer mix is Medicaid‑dominant: reported lifetime Medicaid revenue is $35.8M compared with $7M in Medicare, so the provider operates at a much larger scale on Medicaid volumes while still maintaining measurable Medicare activity. This dual‑payer footprint indicates the business is not single‑payer but relies heavily on state Medicaid flows for overall revenue.
Revenue concentration differs by payer: the top three Medicare codes account for 33.5% of this provider's Medicare revenue, while the top three Medicaid codes account for 26.0% of Medicaid revenue. That concentration shows a meaningful share of payer-specific revenue tied to a small set of high-volume lab panels and phlebotomy/molecular tests.
Business and service‑line mix indicates a full‑service clinical laboratory with both high-throughput routine testing and higher‑complexity services: Medicare top codes include 80053 (CMP), 36415 (venipuncture), and 84443 (TSH), and Medicaid top codes include 80050 (general health panel), 82306 (vitamin D), and 81513 (molecular BV test). The presence of large volumes for routine chemistry, phlebotomy, immunoassays, and algorithmic molecular tests suggests operations that combine volume processing with specialized molecular diagnostics and anatomic pathology support.
Medicare competitive standing shows unusually large national volumes on routine lab codes: 80053 ranks #60 of 26416 providers nationally (100th percentile; extreme outlier) and 36415 ranks #60 of 86467 (100th percentile; extreme outlier), while 84443 ranks #62 of 19722 (100th percentile; notably above typical national volume). These ranks indicate the provider is a national high‑volume outlier for core specimen collection and common chemistry/endocrine assays on Medicare.
Medicaid competitive standing is similarly strong in‑state for both routine panels and specialized tests: 80050 ranks #2 of 33 providers in‑state (97th percentile; notably above typical state volume), 82306 ranks #2 of 70 (99th percentile; extreme outlier), and 81513 ranks #2 of 14 (92th percentile; notably above typical state volume). This profile positions the provider as a top in‑state performer for vitamin D testing, general health panels, and key molecular diagnostics.
Pathology and anatomic services are material to the business: Medicare shows 88305 at $387.5K (8.3% of Medicare revenue) with a national rank of #275 (98th percentile; notably above typical volume), and 88307 appears on Medicare with a rank of #13 of 8511 (100th percentile; extreme outlier). On Medicaid, 88305 generates $1.2M (5.0% of Medicaid revenue) and ranks #7 in‑state (87th percentile). These entries indicate a significant surgical pathology component alongside high-volume clinical lab testing.
The provider shows high Medicaid volumes in infectious disease and molecular testing lines: Medicaid entries include 87591 and 87491 (each $1.4M), 87633 ($1M), and 81513 ($1.4M), with in‑state ranks generally in the upper percentiles. This pattern signals substantial STD and respiratory/multiplex molecular testing activity in the state Medicaid market, reinforcing the lab’s role in public health and diagnostic testing programs.
Tenure is short but operational scale is large: the NPI was enumerated 2021-10-04 (~5 years ago), yet the provider reports multi‑million-dollar lifetime Medicaid and Medicare revenues and top‑percentile ranks on numerous codes. That combination suggests rapid volume growth or aggregation of high testing volumes within a relatively recent enrollment period.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
389 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 60,370 | $10 | $603.7K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 66,350 | $10 | $530.8K |
| 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… | 27,150 | $20 | $434.4K |
| 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… | 14,360 | $30 | $416.3K |
| 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… | 48,880 | $10 | $391K |
| 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… | 9,690 | $40 | $387.5K |
| 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. | 28,410 | $10 | $369.3K |
| 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. | 5,200 | $40 | $208K |
| 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).… | 16,820 | $10 | $168.2K |
| 84439 | The lab analyst performs a test to measure free thyroxine, or free T4, typically in patient serum. | 13,210 | $10 | $118.9K |
Showing 1–10 of 389
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 389 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
389 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 83521 | 1 | 10 | 4,420 | $20 | $74.9K |
| 83880 | 1 | 10 | 1,730 | $40 | $66.7K |
| 88185 | 1 | 10 | 2,880 | $20 | $48.2K |
| 87505 | 1 | 10 | 380 | $130 | $47.1K |
| 81513 | 1 | 10 | 280 | $140 | $38.2K |
| 83970 | 1 | 10 | 100 | $40 | $37.7K |
| 86480 | 1 | 10 | 600 | $60 | $36.6K |
| 87798 | 11 | 10 | 350 | $30 | $34.2K |
| 88305 | 1 | 70 | 530 | $30 | $28.5K |
| 86003 | 1 | 10 | 5,450 | $10 | $27.9K |
Showing 1–10 of 389
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.
310 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 57,700 | $50 | $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… | 56,900 | $30 | $1.7M |
| 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… | 11,500 | $130 | $1.4M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 36,570 | $40 | $1.4M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 36,560 | $40 | $1.4M |
| 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. | 101,460 | $10 | $1.3M |
| 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… | 12,850 | $90 | $1.2M |
| 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. | 111,440 | $10 | $1.1M |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 156,060 | $10 | $1.1M |
| 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… | 2,430 | $430 | $1M |
Showing 1–10 of 310
How this provider's Medicaid billing volume and revenue compare to other New Mexico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Mexico median
310 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 18 | 30 | 3,760 | $120 | $900.7K |
| 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. | 24 | 80 | 3,340 | $60 | $595K |
| 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 | 820 | $230 | $553.6K |
| 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… | 8 | 40 | 880 | $80 | $527.4K |
| 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… | 3 | 20 | 790 | $240 | $493.1K |
| 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… | 2 | 10 | 350 | $120 | $373.8K |
| 0241U | N/A | 21 | 30 | 1,080 | $150 | $353.2K |
| 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… | 3 | 20 | 250 | $410 | $330.3K |
| 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… | 15 | 50 | 530 | $90 | $323.8K |
| 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… | 7 | 50 | 1,740 | $60 | $317.5K |
Showing 1–10 of 310
Other providers in the same ZIP code as Tricore Inc., ranked by combined Medicare and Medicaid revenue.
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