Lab
Pinnacle Health Management, LLC
Pinnacle Health Management, LLC was paid $13.37M by Medicaid between Jan 2018 and Dec 2024, across 62 billing codes. Its largest line is 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 throughput technologies as described by cms-2020-01-r — 37% of everything it billed.
33Billing provider infoPINNACLE HEALTH MANAGEMENT, LLC
HYDEN, KY 41749
HYDEN, KY 41749
33aNPI1306104047assigned 05/01/2012
33bProvider typeClinical Medical Laboratory
28Total paid$13.37M
24GClaims491,828
24DCodes billed62
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Clinical Medical Laboratory providers in Kentucky
Rank by total paid#10 of 73
Median peer was paid$95K
This provider vs. median141×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 17,659 | $830K | |
| 2019 | 21,229 | $923K | |
| 2020 | 28,103 | $1.10M | |
| 2021 | 161,710 | $3.43M | |
| 2022 | 155,782 | $3.15M | |
| 2023 | 64,347 | $2.18M | |
| 2024incomplete | 42,998 | $1.76M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 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 throughput technologies as described by cms-2020-01-r | 37% | 112,653 | 65,197 | $4.91M |
| 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 not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed | 13% | 19,917 | 17,083 | $1.69M |
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | 10% | 36,292 | 31,585 | $1.38M |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 7.6% | 26,106 | 22,988 | $1.02M |
| 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 not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed | 7.2% | 14,453 | 11,635 | $966K |
| U0005 | 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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 | 6.9% | 105,409 | 60,331 | $924K |
| 87798 | Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism | 4.6% | 2,503 | 2,244 | $618K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 2.8% | 21,458 | 6,225 | $380K |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 2.0% | 16,497 | 15,577 | $274K |
| 87481 | 1.4% | 2,049 | 1,814 | $186K | |
| 80074 | <1% | 4,048 | 3,854 | $128K | |
| 84443 | Thyroid stimulating hormone (TSH) | <1% | 11,367 | 10,712 | $111K |
50 more codes
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | <1% | 3,566 | $86K |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | <1% | 3,566 | $86K |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | <1% | 4,483 | $71K |
| 82607 | <1% | 7,642 | $67K | |
| 80053 | Comprehensive metabolic panel | <1% | 9,544 | $57K |
| 87641 | <1% | 2,460 | $47K | |
| 87500 | <1% | 2,410 | $46K | |
| 87651 | Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe | <1% | 2,393 | $46K |
| 80061 | Lipid panel | <1% | 5,184 | $39K |
| 87653 | <1% | 2,104 | $39K | |
| 83013 | <1% | 496 | $22K | |
| 82728 | <1% | 2,403 | $21K | |
| 86762 | <1% | 1,525 | $16K | |
| 86803 | <1% | 1,754 | $15K | |
| 84439 | <1% | 2,600 | $13K | |
| 84481 | <1% | 1,218 | $12K | |
| 83540 | <1% | 2,543 | $10K | |
| G0472 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) | <1% | 568 | $10K |
| G2024 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source | <1% | 50,804 | $9K |
| 87340 | <1% | 1,280 | $8K | |
| 83735 | <1% | 1,993 | $8K | |
| 86706 | <1% | 924 | $8K | |
| 87633 | Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets | <1% | 20 | $6K |
| G0475 | Hiv antigen/antibody, combination assay, screening | <1% | 559 | $6K |
| 86592 | <1% | 1,517 | $4K | |
| 86780 | <1% | 368 | $3K | |
| 83690 | <1% | 762 | $3K | |
| 86704 | <1% | 340 | $3K | |
| 87801 | Infectious agent detection by nucleic acid; amplified probe, multiple organisms | <1% | 52 | $3K |
| 83550 | <1% | 525 | $2K | |
| 86431 | <1% | 756 | $2K | |
| 87802 | <1% | 226 | $2K | |
| 82150 | <1% | 454 | $2K | |
| 83002 | <1% | 151 | $2K | |
| G0499 | Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to hepatitis b core antigen (anti-hbc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive hbsag result | <1% | 119 | $2K |
| 87640 | <1% | 250 | $2K | |
| 82746 | <1% | 162 | $1K | |
| 83525 | <1% | 297 | $1K | |
| 84146 | <1% | 105 | $1K | |
| 82670 | <1% | 55 | $1K | |
| 84550 | <1% | 465 | $1K | |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | <1% | 107 | $599.48 |
| 80305 | <1% | 111 | $553.62 | |
| 87581 | <1% | 20 | $549.49 | |
| 87486 | <1% | 20 | $549.49 | |
| 84144 | <1% | 20 | $399.22 | |
| 80048 | Basic metabolic panel (calcium, ionized) | <1% | 48 | $290.01 |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | <1% | 53 | $239.69 |
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 15 | $127.31 |
| 99499 | 0% | 39 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialMARTIN, TONYA (MEMBER)
| Provider | Location | Paid |
|---|---|---|
| Edwin Liu, MD PA | Loxahatchee, FL | $5.97M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.