5 Proven Strategies to Protect and Increase Your Lab's Revenue in 2025

It’s a constant conflict: Every year, clinical laboratories are expected to do more—be it add test volume, improve turnaround times, or decrease costs—with fewer resources and staff. Because of this added pressure, innovative ways to increase lab revenue have become more important than ever.

Unfortunately, improved reimbursement rates will not be the answer. While the U.S. federal government has again postponed lab test rate cuts proposed by the Protecting Access to Medicare Act (PAMA), this yearly exercise merely delays the inevitable.

However, there are several options that clinical lab leaders can explore in 2025 to improve their budget outlook.

Here are five key strategies for increasing your lab’s revenue:

Generating new revenue streams

Upgrading select testing methods can create an opportunity to draw in more revenue. Certain test methods are reimbursed at a higher rate than others, often due to increased complexity, such as converting from an antigen or culture method toward a NAAT method for Group A Strep. Although converting may be accompanied by higher operational expense, the spread between revenue and expense is wider in NAAT than in antigen, padding operational margins. Consider this example of converting to Group A Strep PCR that demonstrates how a method change would increase net revenue by nearly $200,000. This example also shows how a test method change can also generate operational savings through improved staff efficiencies.  

Universal opt-out screening for infectious diseases can be used to meet recommended screening protocols while adding additional revenue. As highlighted in a recent Today's Clinical Lab webinar, the United States preventive task force has developed recommendations for universal screening of select diseases, assigning Hepatitis B, Hepatitis C, and HIV national coverage designation. While these recommendations were introduced in 2016, laboratories and health systems may not be practicing universal screening, which means potentially thousands of patients per health system may not be tested according to the recommended frequency. By implementing universal screening, laboratories can pull forward a significant volume of testing that has national coverage with a high probability of payment. 

Another option to increase revenue is onboarding recently FDA-approved assays. The following recently FDA-approved tests could add new revenue to your laboratory operations:

• Beta-Amyloid
• Total-Tau
• Fentanyl
• Buprenorphrine
• Neurofilament Light Chain
• Lipoprotein a

Apolipoprotein B (apoB) is another intriguing test menu addition, as it’s already available on many vendor platforms. Clinical guidance on lipid testing is giving more significance to routine use of apoB measurements in atherosclerotic cardiovascular disease, a trend that may increase test volumes.

Improving lab revenue integrity

The relationship between lab and coding/billing should be a collaboration that provides new opportunities to add and capture all potential revenue for a lab. Understanding trends in denials can be used to improve revenue collection and receive quicker payment, ensuring labs are being paid for the work performed. 

Reclaiming denials with modifiers

Modifiers are one opportunity to recapture denied payments. Many modifiers exist and their respective descriptions for appropriate use can be found in the American Medical Association CPT code book. A few examples of modifiers include the TC, 91, and 59 modifiers. 

TC modifiers are used to indicate the technical performance portion of a laboratory test, ensuring payment when the test also includes a professional service. An example of when to use the TC modifier would be on CPT 88305 for surgical pathology, gross and microscopic examination. This would apply when the pathologist performing the examination is billing for the professional component.

The 59 modifier may be used in a scenario when different anatomical specimens were collected during the same procedure. A denial of CPT 88304 or 88305 may result when multiple charges exist on the claim without the 59 modifier.

Repeat laboratory procedures on the same day of service are often met with denials. The 91 modifier can be used to demonstrate a repeat laboratory service on the same day when needed for clinical treatment of the patient. This may be a nursing home patient with a critical sodium who becomes admitted for observation and repeat sodium assessment. 

For more in-depth information on modifiers, be sure to reference expert sources on appropriate use such as this recent G2 Intelligence webinar on recent NCCI policy and application of rules.

Reducing missing charges

Labs perform hundreds to thousands of different tests, each with its own CPT number to codify the testing performed. In addition to testing codes, there are numerous processing or special testing protocols that also carry a CPT code. 

A brief review of some common CPT codes within this category are below:

Additionally, it is best practice to ensure that all testing protocols are billing out a CPT code. A recent review within our own system found CPT codes missing when billing for a CSF cell count and differential (89050 & 89051). 

Expanding operating margins

Some labs may prefer to bill for testing sent to a larger referral lab. This is done for a variety of reasons such as a single patient invoice, insurance coverage restrictions, and potential revenue generation. All are valid reasons to hold on to this practice when allowed by the patient’s insurance. 

However, there are instances when it is financially beneficial to allow the third party laboratory to bill the patient’s insurance. This is especially true for some pathology procedures. Understanding the payment amount being received for specialty testing and comparing it against the client invoice amount can be especially enlightening. This simple comparison helped our lab identify opportunities to allow third party reference labs to bill patient insurance directly. Though accompanied by a drop in laboratory revenue, a similar or greater reduction in expense will result in an expansion of the operating margin. 

Be proactive to protect lab revenue

While a reprieve from reduced Medicare payments has been delayed for now, laboratories need to continue to identify opportunities to add ballast to their operational margins. This may be achieved through the various tactics described above by generating new income, collecting revenue due, or reducing operational expenses. These tactics will prepare clinical labs for future cuts while sustaining continued investments in laboratory operations and supporting laboratory growth.