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 North Carolina for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Wake Forest University Health Sciences (NPI 1003803032)

Wake Forest University Health Sciences is a multi-specialty clinic/center provider located in Winston Salem, North Carolina. This profile covers 0 Medicare and 470 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	Wake Forest University Health Sciences
Address	Medical Center Blvd
City	Winston Salem
State	NC
ZIP	27157
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	October 4, 2005

Payer Source	Total Paid
Medicaid	$188.2M
Medicare	$0

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

470 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	3,478,600	$10	$24.4M
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…	505,010	$50	$23.7M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	386,440	$60	$23.6M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	151,540	$110	$17.1M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	191,290	$90	$16.6M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	61,050	$80	$5M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	111,340	$40	$4.9M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	88,060	$50	$4.1M
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…	63,510	$60	$4.1M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	39,900	$90	$3.4M

Showing 1–10 of 470

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Wake Forest University Health Sciences — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

470 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	4	330	6,130	$130	$2.7M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	12	320	6,160	$120	$2.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	3	280	2,690	$130	$1.6M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	8	20	2,430	$300	$1.5M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	4	10	1,880	$290	$1.4M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	5	20	3,950	$100	$740.3K
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.	453	520	2,870	$70	$721.7K
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…	106	150	860	$50	$586.6K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	48	80	750	$120	$449.7K
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	10	160	490	$100	$435.6K

Showing 1–10 of 470

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Wake Forest University Health Sciences	NC	Multi-Specialty Clinic/Center	$0	$11.9M
Afc Urgent Care And Family Care Of Wnc, PLLC	NC	Urgent Care Clinic/Center	$0	$9.4M
Keegan Harkins	NE	Ophthalmology Physician	$3.5M	$0
Jedediah Mcclintic	PA	Ophthalmology Physician	$3.2M	$18.9K
Claudia Hooten	TX	Retina Specialist (Ophthalmology) Physician	$2.6M	$0
Donald Vile	VA	Hematology & Oncology Physician	$1.4M	$0
Mark Nelson	NC	Retina Specialist (Ophthalmology) Physician	$1.1M	$0
Omar Sangueza	NC	Dermatopathology (Pathology) Physician	$810.1K	$0
Brian Zamora	NC	Retina Specialist (Ophthalmology) Physician	$793.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
North Carolina Baptist Hospital	NC	General Acute Care Hospital	$0	$138.4M
Wake Air Care LLC	NC	Air Ambulance	$2.5M	$2.4M
Vishak John	NC	Ophthalmology Physician	$4.3M	$0
Thomas Williamson	NC	Hematology & Oncology Physician	$2.4M	$0
Jennifer Stanislaus	NC	Anesthesiology Physician	$557.1K	$0
Thomas Sullivan	NC	Diagnostic Radiology Physician	$18.9K	$393.7K
Rajiv Shah	NC	Ophthalmology Physician	$328.3K	$0
Bradley Unruh	NC	Diagnostic Radiology Physician	$279.6K	$0
Jordan Allem	NC	Cardiovascular Disease Physician	$257.3K	$0
Craig Greven	NC	Ophthalmology Physician	$226.4K	$0

Wake Forest University Health Sciences — 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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