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NPI 1851959928 · Roanoke, VA · Clinical Medical Laboratory
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Quest Diagnostics Clinical Laboratories Inc is a clinical medical laboratory provider located in Roanoke, Virginia. This profile covers 165 Medicare and 83 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 | 1906 Belleview Ave Se |
| City | Roanoke |
| State | VA |
| ZIP | 24014 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | June 3, 2019 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.9M |
| Medicaid | $186.2K |
This provider operates as a high-volume clinical diagnostic laboratory focused on routine chemistry, lipid, endocrine, hematology and infectious-disease testing — its top Medicare codes are 80053, 80061 and 84443, which align to CMP, lipid panel and TSH testing and together account for 39.5% of its Medicare revenue. The Medicare top-code list also shows large volumes for specimen collection and CBC (36415 and 85025), indicating an integrated phlebotomy-to-analysis workflow rather than a narrow specialty service.
Medicare revenue is concentrated in a few routine panels: 80053 produced $493.7K (14.7% of Medicare revenue), 80061 produced $447.4K (13.3%), and 84443 produced $384.2K (11.5%), and those three codes collectively account for 39.5% of total Medicare revenue. This concentration around common chemistry and endocrine assays suggests the lab’s business depends heavily on high-throughput panel testing for outpatient populations.
On Medicaid the revenue mix is similarly concentrated in a small set of tests: 80053 accounted for $22.7K (13.0%), 84443 for $19.3K (11.1%), and 86803 for $17.7K (10.2%), with the top three codes together representing 34.3% of this provider’s Medicaid revenue. The Medicaid code list emphasizes screening and core panels (including hepatitis C antibody testing under 86803), suggesting the lab provides the same basic panel and infectious-disease screening services to both payers.
Scale of activity is heavily skewed to Medicare: total Medicare revenue is $3.9M versus total Medicaid revenue of $186.2K, indicating Medicare is the dominant payer by an order of magnitude. This disparity makes the provider effectively Medicare-first in scale, with Medicaid representing a much smaller portion of its billed business.
National competitive standing on Medicare is strong for many routine codes: 80053 ranks #65 of 26416 providers (100th percentile) and 80061 ranks #61 of 21671 providers (100th percentile), while 36415 ranks #88 of 86467 providers (100th percentile) and is labeled an “extreme outlier, far above typical national volume.” These rank/percentile placements indicate the provider is a major national-volume performer for common panels and specimen collection.
By contrast, the provider’s Medicaid footprint is more modest within-state: 80053 ranks #101 of 231 providers in-state (57th percentile) and 80061 ranks #44 of 224 providers in-state (81th percentile), while 86803 ranks #22 of 98 providers in-state (78th percentile). Those in-state percentiles describe a service profile that is typical to moderately above typical among local peers rather than dominant statewide.
Several codes are flagged as statistical outliers in the national Medicare data, highlighting areas of exceptional volume: 36415 and 80048 are described as “extreme outlier, far above typical national volume,” and multiple high-volume chemistry codes (for example 80053 and 80061) are noted as “notably above typical national volume.” These labels imply unusually large specimen throughput and test automation capacity relative to most providers.
The provider has been enumerated since 2019-06-03 (~7 years ago), and in that timeframe it reports national-scale Medicare volumes across many routine tests. Tenure combined with the volume and code mix is consistent with an established clinical laboratory operation that handles large outpatient testing volumes and centralized processing rather than a small local clinic lab.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
165 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. | 49,370 | $10 | $493.7K |
| 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. | 34,420 | $10 | $447.4K |
| 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… | 24,010 | $20 | $384.2K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 34,610 | $10 | $276.9K |
| 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… | 30,330 | $10 | $242.6K |
| 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… | 19,170 | $10 | $153.4K |
| G0472 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) | 3,150 | $50 | $141.7K |
| 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).… | 13,220 | $10 | $132.2K |
| 83880 | The lab analyst measures the amount of natriuretic peptide, a hormone made by heart muscle cells, in the patient specimen. Blood levels of the hormone increase in patients with congestive heart… | 3,450 | $40 | $131.1K |
| 84153 | The lab analyst performs testing for total prostate specific antigen, PSA, typically on serum or plasma samples using laboratory analyzers. PSA is a protein the prostate gland produces, and… | 6,300 | $20 | $113.3K |
Showing 1–10 of 165
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 165 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.
83 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. | 7,550 | $1 | $22.7K |
| 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… | 3,860 | $10 | $19.3K |
| 86803 | Qualitative or Semiquantitative Immunoassays; Hepatitis C antibody | 1,610 | $10 | $17.7K |
| 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. | 4,410 | $1 | $17.6K |
| 87086 | Culture, bacterial; quantitative, colony count, urine. | 3,670 | $1 | $14.7K |
| 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… | 5,800 | $1 | $11.6K |
| 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).… | 3,010 | $1 | $9K |
| 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… | 4,500 | $1 | $9K |
| 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… | 4,120 | $1 | $8.2K |
| 87340 | The lab analyst performs a test to detect hepatitis B surface antigen, also called HBsAg, using an immunoassay technique, such as EIA. | 960 | $10 | $7.6K |
Showing 1–10 of 83
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
83 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… | 107 | 110 | 1,150 | $40 | $331.1K |
| 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… | 82 | 100 | 2,220 | $40 | $214.2K |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 24 | 20 | 350 | $30 | $170.5K |
| 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. | 101 | 230 | 5,240 | $1 | $93.2K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 105 | 130 | 1,430 | $10 | $54.5K |
| 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… | 85 | 180 | 3,920 | $1 | $50.3K |
| 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… | 108 | 140 | 390 | $10 | $44.8K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 104 | 130 | 1,390 | $10 | $37.4K |
| 83880 | The lab analyst measures the amount of natriuretic peptide, a hormone made by heart muscle cells, in the patient specimen. Blood levels of the hormone increase in patients with congestive heart… | 104 | 110 | 3,130 | $10 | $34.3K |
| 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… | 61 | 170 | 2,050 | $10 | $30.4K |
Showing 1–10 of 83
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 |
|---|---|---|---|---|
| Carilion Medical Center | VA | General Acute Care Hospital | $0 | $124.7M |
| Carilion Medical Center | VA | Multi-Specialty Clinic/Center | $0 | $73.4M |
| Carilion Medical Center | VA | Emergency Medicine Physician | $0 | $18.1M |
| Carilion Emergency Services, Inc. | VA | Urgent Care Clinic/Center | $0 | $11.1M |
| Carilion Clinic Patient Transportation, LLC | VA | Air Ambulance | $2.6M | $6.1M |
| Mark Kochenderfer | VA | Hematology & Oncology Physician | $2.5M | $0 |
| Amanda Gillespie-twardy | VA | Hematology & Oncology Physician | $1.9M | $0 |
| Suzan Merten | VA | Hematology & Oncology Physician | $1.8M | $90 |
| Padmaja Mallidi | VA | Hematology & Oncology Physician | $1.7M | $0 |
| Fairlawn Surgery Center, LLC | VA | Ambulatory Surgical Clinic/Center | $997K | $572.4K |
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