Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Minnesota for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Minnesota only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Minnesota (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Fulcrum Health, Inc. (NPI 1003000969)

Fulcrum Health, Inc. is a exclusive provider organization provider located in Plymouth, Minnesota. This profile covers 0 Medicare and 26 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Fulcrum Health, Inc.
Address	3300 Fernbrook Lane North
City	Plymouth
State	MN
ZIP	55447
Taxonomy	Exclusive Provider Organization
NPI Enumerated	September 4, 2007

Payer Source	Total Paid
Medicaid	$10.1M
Medicare	$0

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
98941	The provider applies manipulation to influence joint and neurophysiological function by a variety of techniques and modalities in three to four spinal regions.	263,960	$30	$6.9M
98940	The provider applies manipulation to influence joint and neurophysiological function by a variety of techniques and modalities in one to two spinal regions.	76,250	$20	$1.5M
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	10,090	$40	$423.9K
97810	The provider uses solid, metallic, fine, single–use needles to pierce the skin and stimulate anatomical points on or in the skin by manipulating the needles by hand during an initial 15 minute…	18,980	$20	$360.5K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	9,860	$30	$305.7K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	4,770	$30	$152.5K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	6,650	$20	$132.9K
72100	The technician takes 2 or 3 views of the vertebrae in the lumbar region which is the lower part of the spine and the sacrum, the area that connects the spine to the pelvis. Lumbosacral spine X–rays…	2,310	$30	$62.4K
97813	The provider uses solid, metallic, fine, single–use needles to pierce the skin and stimulate anatomical points on or in the skin by manipulating the needles by electrical stimulation for an initial…	2,390	$20	$57.3K
72040	The patient has a 2– or 3–view X–ray of the neck vertebrae.	2,000	$30	$50K

Showing 1–10 of 26

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Minnesota providers billing the same CPT/HCPCS codes.

Claims Volume vs. Minnesota Distribution

Fulcrum Health, Inc. — 7 of 17 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Minnesota

Full comparison — all codes billed, vs. Minnesota median

26 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	356	1,200	1,030	$70	$549.7K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	207	260	890	$60	$405.3K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	56	300	700	$30	$135.4K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	42	160	200	$50	$119.6K
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	16	450	140	$60	$101.3K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	26	130	670	$20	$85.2K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	25	490	170	$60	$81.4K
97811	The provider pierces the skin using one or more needles and stimulates anatomical points on or in the skin by manipulating the needles by hand. This code represents each additional 15 minutes of…	13	70	660	$30	$63.5K
98941	The provider applies manipulation to influence joint and neurophysiological function by a variety of techniques and modalities in three to four spinal regions.	1	750	840	$20	$57.9K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	5	260	80	$50	$42.7K

Showing 1–10 of 26

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Grant Williams	WI	Chiropractor	$20.5K	$213.9K
Matthew Betterton	IA	Chiropractor	$40.9K	$121.9K
Robert Swenson	WI	Chiropractor	$8.4K	$141.6K
Alan Weber	WI	Chiropractor	$43.5K	$102.3K
Christopher Wood	MN	Chiropractor	$48.8K	$72.7K
Mikhail Kirnus	ND	Cardiovascular Disease Physician	$117.9K	$0
Ryan Swenson	SD	Chiropractor	$25.5K	$77.4K
Tiffany Thiesse	SD	Chiropractor	$15.3K	$85.2K
Gregory Gruba	SD	Chiropractor	$19.7K	$73K
Scott Hopfinger	SD	Chiropractor	$22.2K	$66K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Metropolitan Anesthesia Network, LLP	MN	Anesthesiology Physician	$0	$16.8M
Generation Care Inc.	MN	Home Health Agency	$0	$12.3M
Wayzata Public Schools	MN	Local Education Agency (LEA)	$0	$6.4M
Autism Matters, Inc.	MN	Speech-Language Pathologist	$0	$5.5M
Equimed Corporation	MN	Specialist	$828.3K	$30
Adam Schmitt	MN	MOHS-Micrographic Surgery Physician	$240.3K	$0
Kelsey Mason	MN	Nurse Practitioner	$172.3K	$37.2K
Grand St Paul Cvs LLC	MN	Pharmacy	$85.7K	$0
Sandra Montezuma	MN	Ophthalmology Physician	$69K	$0
Yazdaan Juma	MN	Family Medicine Physician	$36K	$0

Fulcrum Health, Inc. — Billing Profile & Reimbursement Data

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Fulcrum Health, Inc. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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