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NPI 1952347791 · Marlborough, MA · Clinical Medical Laboratory
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Quest Diagnostics LLC is a clinical medical laboratory provider located in Marlborough, Massachusetts. This profile covers 544 Medicare and 421 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 LLC |
| Address | 200 Forest St |
| City | Marlborough |
| State | MA |
| ZIP | 01752 |
| 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 | $209.7M |
| Medicare | $27.2M |
QUEST DIAGNOSTICS LLC is operating as a very large-volume clinical medical laboratory in Marlborough, MA, with an NPI enumerated since 2006-06-21 (~20 years ago), indicating long tenure and likely sustained operations and contracts in the region. The claim mix across Medicare and Medicaid shows heavy laboratory service lines: high volumes of routine chemistry and hematology panels, molecular infectious disease testing, and both presumptive and definitive drug testing.
Medicaid is the dominant payer for this location by scale: the provider reports Total Medicaid revenue of $209.7M versus Total Medicare revenue of $27.2M, making Medicaid the primary source of billing volume and revenue for this entity. This payer mix suggests operational emphasis on services commonly reimbursed by Medicaid in-state, including high-volume NAAT and infectious-disease panels and population screening tests.
Revenue concentration is substantial on both payers. Precomputed top-3 figures show the top 3 Medicare codes account for 33.0% of this provider's total Medicare revenue, while the top 3 Medicaid codes account for 52.9% of its total Medicaid revenue, indicating material dependence on a small set of high-revenue tests for each payer.
For Medicare the leading codes are high-volume, routine lab services: 36415 (2.3M revenue, 283.2K claims), 80053 (1.8M revenue, 184.1K claims), and 80061 (1.8M revenue, 138.8K claims). Those codes and related panels (e.g., 84443, 82306, 85025) rank at or near the 100th percentile nationally and are described as "extreme outlier" volumes, which characterizes the provider as a major national processor of routine lab specimens under Medicare.
On Medicaid the revenue mix is dominated by molecular and toxicology testing: 80307 (1.2M claims, $32.5M revenue), U0003 (577.4K claims, $30M revenue), and G0480 (950.7K claims, $19M revenue) are the top drivers. Each of these Medicaid codes ranks at the top statewide (many #1 in-state) and are labeled as "extreme outlier", indicating Quest Diagnostics is a dominant in-state provider for COVID PCR testing and definitive drug testing as well as high-volume presumptive drug screens.
Competitive standing differs by payer and test type: nationally, the provider is an extreme outlier on many common Medicare lab codes (multiple codes at the 100th percentile and high national ranks), signaling outsized market share or centralized processing nationally for routine lab work. Statewide in Massachusetts it similarly dominates multiple Medicaid codes (U0003, G0480, 80307, and numerous STI/NAAT codes all rank #1 in-state), indicating a leading position in the state’s Medicaid lab market for molecular, infectious-disease, and toxicology testing.
The code-level profiles suggest operational capabilities: the combination of very large claims counts for U0003 and other NAAT codes, plus high volumes for G0480 and 80307, point to high-throughput molecular and toxicology lab capacity and specimen collection throughput. Concurrently, very large volumes for routine chemistry and hematology panels (80053, 80061, 85025) indicate broad clinical laboratory services rather than a narrow niche.
Concentration and operational risk should be noted: Medicaid revenue is particularly concentrated with the top three Medicaid codes accounting for 52.9% of Medicaid revenue, and single codes like 80307 and U0003 each representing double-digit percentages of total Medicaid revenue. If payer policies or testing demand for those specific services shift, the provider’s Medicaid revenue exposure could be meaningfully affected given the current dependence on a small set of high-revenue tests.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
544 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. | 283,240 | $10 | $2.3M |
| 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. | 184,050 | $10 | $1.8M |
| 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. | 138,830 | $10 | $1.8M |
| 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… | 110,650 | $20 | $1.8M |
| 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… | 47,100 | $30 | $1.4M |
| 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… | 153,330 | $10 | $1.2M |
| 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… | 10,220 | $110 | $1.1M |
| 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).… | 76,100 | $10 | $761K |
| 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. | 11,040 | $60 | $673.1K |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 42,140 | $20 | $632K |
Showing 1–10 of 544
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 544 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
544 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 83698 | 2 | 10 | 1,030 | $50 | $288.5K |
| 83876 | 2 | 10 | 360 | $50 | $243.6K |
| 81513 | 2 | 10 | 1,420 | $140 | $166.4K |
| 83704 | 2 | 10 | 1,210 | $30 | $150.5K |
| 82542 | 2 | 10 | 1,670 | $20 | $126K |
| 87088 | 2 | 10 | 7,290 | $10 | $123.3K |
| 83921 | 3 | 10 | 1,280 | $20 | $122.5K |
| 86480 | 1 | 10 | 2,550 | $60 | $109.2K |
| 83695 | 2 | 10 | 2,440 | $10 | $107K |
| G0480 | 2 | 50 | 130 | $110 | $105.4K |
Showing 1–10 of 544
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.
421 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 1,204,520 | $30 | $32.5M |
| 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… | 577,390 | $50 | $30M |
| 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… | 950,710 | $20 | $19M |
| 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… | 82,910 | $90 | $7M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 522,090 | $10 | $5.7M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 521,950 | $10 | $5.7M |
| 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… | 526,490 | $10 | $5.3M |
| 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… | 519,850 | $10 | $5.2M |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 134,360 | $30 | $4.4M |
| 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… | 1,084,290 | $1 | $4.3M |
Showing 1–10 of 421
How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts median
421 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 10 | 20 | 310 | $260 | $2.1M |
| 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 | 1,720 | $430 | $1.2M |
| 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 | 130 | 1,830 | $60 | $974.3K |
| 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… | 6 | 30 | 270 | $290 | $731.4K |
| 81329 | The lab analyst performs the technical lab test to detect deletions in the survival of motor neuron 1 (SMN1), telomeric, gene and may also analyze the survival of motor neuron 2 (SMN2), centromeric,… | 5 | 10 | 1,210 | $50 | $714K |
| 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. | 2 | 370 | 500 | $40 | $605.1K |
| 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… | 1 | 200 | 450 | $30 | $511.5K |
| 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 | 520 | $70 | $468.5K |
| 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… | 4 | 20 | 440 | $100 | $385.6K |
| 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)… | 33 | 100 | 290 | $120 | $356.6K |
Showing 1–10 of 421
Other providers in the same ZIP code as Quest Diagnostics LLC, ranked by combined Medicare and Medicaid revenue.
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