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NPI 1881697464 · Louisville, KY · Anatomic Pathology & Clinical Pathology Physician
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Clinical Associates, LLC is a anatomic pathology & clinical pathology physician provider located in Louisville, Kentucky. This profile covers 272 Medicare and 326 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 | Clinical Associates, LLC |
| Address | 2935 Breckenridge Ln Ste 101 |
| City | Louisville |
| State | KY |
| ZIP | 40220 |
| Taxonomy | Anatomic Pathology & Clinical Pathology Physician |
| NPI Enumerated | May 27, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $60.7M |
| Medicare | $1.8M |
Payer mix is heavily skewed toward Medicaid: the entity reported $60.7M in lifetime Medicaid revenue versus $1.8M in lifetime Medicare revenue, indicating Medicaid is the primary source of billed revenue and the practice is not balanced across the two payers. This scale difference suggests the organization operates primarily within Medicaid-funded care pathways or contracts rather than relying on Medicare volume.
Medicare revenue shows concentrated drivers: the provider’s top three Medicare codes (88305, 81513, 81479) account for 30.3% of total Medicare revenue. The mix — led by 88305 (surgical pathology) and supported by molecular/algorithmic tests like 81513 and uncoded molecular work under 81479 — indicates a combined pathology and targeted molecular testing operation in its Medicare business line.
Medicaid revenue is also concentrated in a small set of high-volume infectious-disease/STI codes: 87591, 87491, and 87661 together make up 30.9% of Medicaid revenue. Each of these codes individually generates multi-million dollar revenue (87591: $4.9M; 87491: $4.9M; 87661: $4.1M) and very large claim counts (e.g., 138.9K and 138.7K claims), which points to an operational emphasis on large-scale nucleic-acid–based STI testing.
Competitive standing on Medicare is mixed but includes high national volume for core pathology and routine lab work: 88305 ranks #400 of 14580 (97th percentile) and common panels such as 85025 and 80053 are at the 99th percentile nationally. These percentiles and ranks characterize the provider as notably above typical national volume for several routine and pathology services rather than a marginal participant in Medicare lab markets.
On Medicaid the provider is a dominant statewide performer for many infectious and screening tests: multiple top Medicaid codes (including 87591, 87491, 87661, 81513, 87481, 87389, 87624, 87086, 86803, 87340) are listed as 100th percentile or described as “extreme outlier” and several rank #1 in-state. That pattern is consistent with the provider acting as a major centralized testing hub or high-volume contract partner for Medicaid-funded STI and public-health screening in Kentucky.
Several routine diagnostic codes show high national percentiles on Medicare (for example, 85025 at the 99th percentile, 80053 at the 99th percentile, 80048 at the 98th percentile), indicating the practice handles substantial volumes of basic hematology and chemistry testing in addition to higher-complexity pathology and molecular work. This breadth suggests an operating model that serves both high-throughput screening/monitoring and specialty pathology workflows.
The Medicaid side contains multiple explicit statistical outliers (labels provided in-state include “extreme outlier” for many STI and infectious-disease codes), which implies revenue concentration that could be sensitive to state program policy, reimbursement changes, or shifts in contracting. Given the absolute dollar amounts attached to those codes (several individual codes ≥ $1.1M–$4.9M), changes in Medicaid reimbursement or referral patterns could materially affect overall revenue.
The provider has an established enumeration history (NPI enumerated 2005-05-27, ~21 years ago), which supports that these billing patterns reflect a long-running operating footprint rather than a short-term or newly scaled program. Tenure combined with consistently high ranks and repeated extreme outlier status in Medicaid strengthens the interpretation of sustained, high-volume lab operations focused on STI and infectious-disease testing alongside pathology services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
272 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… | 7,120 | $30 | $178.1K |
| 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… | 550 | $140 | $77.4K |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 60 | $1,320 | $76.4K |
| 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. | 1,620 | $40 | $64.6K |
| 87086 | Culture, bacterial; quantitative, colony count, urine. | 7,820 | $10 | $62.6K |
| 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… | 500 | $110 | $56.2K |
| 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… | 6,210 | $10 | $49.7K |
| 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. | 4,870 | $10 | $48.7K |
| 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… | 900 | $50 | $46K |
| G0482 | 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… | 240 | $190 | $45.9K |
Showing 1–10 of 272
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 272 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
272 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| G0482 | 7 | 40 | 60 | $190 | $97.3K |
| 81479 | 1 | 10 | 50 | $830 | $39.9K |
| G0481 | 38 | 80 | 130 | $150 | $37.8K |
| 88305 | 2 | 180 | 590 | $30 | $33.2K |
| 81206 | 1 | 10 | 190 | $160 | $30.4K |
| 81513 | 1 | 10 | 30 | $140 | $28K |
| G0145 | 1 | 10 | 1,020 | $30 | $26.5K |
| G0480 | 10 | 130 | 60 | $110 | $25.4K |
| 80307 | 43 | 230 | 150 | $60 | $20.4K |
| G0472 | 2 | 10 | 350 | $50 | $17.4K |
Showing 1–10 of 272
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.
326 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 138,880 | $40 | $4.9M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 138,730 | $40 | $4.9M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 120,490 | $30 | $4.1M |
| 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… | 30,600 | $110 | $3.2M |
| 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… | 39,980 | $80 | $3M |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 64,960 | $40 | $2.5M |
| 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… | 37,440 | $60 | $2.1M |
| 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… | 26,950 | $70 | $1.9M |
| 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… | 22,510 | $80 | $1.9M |
| 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… | 70,660 | $20 | $1.7M |
Showing 1–10 of 326
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
326 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G0483 | 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… | 27 | 70 | 1,650 | $100 | $2M |
| G0482 | 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… | 32 | 50 | 2,830 | $90 | $1.4M |
| G0481 | 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… | 27 | 80 | 990 | $60 | $912.2K |
| 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. | 101 | 340 | 2,700 | $40 | $673.3K |
| 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… | 4 | 30 | 2,090 | $50 | $662.1K |
| 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… | 17 | 140 | 2,000 | $60 | $639.8K |
| 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 | 110 | 2,280 | $50 | $552.6K |
| 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 | 10 | 340 | $100 | $549.4K |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 4 | 50 | 570 | $110 | $393.6K |
| 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… | 3 | 130 | 2,450 | $60 | $382.4K |
Showing 1–10 of 326
Other providers in the same ZIP code as Clinical Associates, LLC, ranked by combined Medicare and Medicaid revenue.
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