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 South Dakota for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Avera Mckennan (NPI 1013980598)

Key Findings

Field	Value
Entity Type	Organization
Organization	Avera Mckennan
Address	4400 W 69th St Ste 1500
City	Sioux Falls
State	SD
ZIP	57108
Taxonomy	Psychiatry Physician
NPI Enumerated	February 7, 2006

Payer Source	Total Paid
Medicaid	$9.1M
Medicare	$0

This provider is effectively single‑payer on file: there is no Medicare billing on file and all reported lifetime federal billing is through Medicaid, totaling $9.1M. The NPI was enumerated on 2006-02-07 (~20 years ago), indicating a long tenure in the market with an established Medicaid footprint.

Revenue concentration is high in a small set of inpatient E/M codes: the precomputed top three Medicaid codes account for 39.3% of the provider’s total Medicaid revenue. Those three are 99232 ($1.2M, 13.5%), 99233 ($1.2M, 13.4%), and 99223 ($1.1M, 12.5%), showing a heavy dependence on hospital inpatient/observation evaluation and management services.

The code mix points to a hospital‑centric psychiatry practice model: high volumes and revenue for inpatient follow‑up and initial admission E/M codes (99232, 99233, 99223) plus meaningful revenue from discharge management codes such as 99239 ($652.1K, 7.2%). This pattern indicates the provider performs a large share of inpatient psychiatric evaluations, ongoing inpatient management, and discharge care rather than being exclusively an office‑based outpatient practice.

Group psychotherapy (90853) is a major outpatient service line for this provider: 26K claims generated $986.5K (10.9% of Medicaid revenue) and the provider ranks #1 of 31 in‑state (100th percentile) as an extreme outlier. That combination of high claim volume and top statewide rank suggests an operational emphasis on group treatment programs or large group therapy panels as a core revenue driver.

The provider also operates a substantial psychological testing and assessment service line: 96131 ($185.5K, 2.0%) and 96130 ($182.5K, 2.0%) both rank #1 in‑state, and related codes 96136 and 96101 appear as top codes. These entries indicate routine standardized testing, interpretation, and reporting are part of the clinical mix and contribute meaningfully to Medicaid revenue.

Competitive standing for key inpatient codes is strong at the state level: 99233 ranks #2 of 41 providers (98th percentile), 99223 ranks #2 of 43 (98th percentile), and 99232 ranks #5 of 69 (94th percentile). Those high percentile placements signal the provider is a major statewide participant in hospital inpatient psychiatric E/M services rather than a marginal or occasional biller for these codes.

Outpatient psychotherapy and office E/M services are also present across multiple codes (for example 99214 $674K, 7.4%; 90832 $356.9K, 3.9%; 90847 $231.2K, 2.6%), showing the organization offers a continuum of care from inpatient management to outpatient individual, family, and group therapy. The presence of higher‑level outpatient E/M codes (99214, 99215) alongside psychotherapy codes suggests blended sessions that include evaluation and management with psychotherapy components.

Because a relatively small set of codes drives a large portion of Medicaid revenue (top three = 39.3%) and 90853 alone accounts for 10.9%, the provider has concentrated operational exposure to changes in inpatient E/M reimbursement and group psychotherapy coverage. For payer or network strategy, this profile indicates both strengths (specialized inpatient and group therapy capacity) and potential revenue sensitivity if utilization or reimbursement for those specific codes shifts.

Medicaid: Complete Services Breakdown

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

36 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	26,000	$50	$1.2M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	20,590	$60	$1.2M
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	9,990	$110	$1.1M
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	25,960	$40	$986.5K
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…	12,480	$50	$674K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	9,450	$70	$652.1K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	7,140	$50	$356.9K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	3,310	$110	$354.1K
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…	4,240	$80	$343K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	3,110	$80	$242.4K

Showing 1–10 of 36

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Avera Mckennan — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

36 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…	77	340	1,010	$100	$511K
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…	13	260	860	$80	$222.6K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	7	70	200	$80	$176.7K
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…	5	70	400	$40	$172.5K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	32	190	430	$90	$154.1K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	2	40	250	$50	$151.7K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	2	20	30	$90	$144.2K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	2	40	160	$90	$116.9K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	1	30	330	$40	$104.9K
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…	4	70	130	$100	$99K

Showing 1–10 of 36

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Vance Thompson Vision Surgery Center Prof LLC	SD	Ambulatory Surgical Clinic/Center	$4.5M	$22.7K
Siouxland Oral Surgery	SD	Oral and Maxillofacial Surgery (Dentist)	$0	$3.9M
Avera Home Medical Equipment, LLC	SD	Durable Medical Equipment & Medical Supplies	$0	$3.4M
Ryan Geraets	SD	Ophthalmology Physician	$3M	$0
Anderson-smith Speech Therapy, LLC	SD	Speech-Language Pathologist	$0	$1.9M
Ophthalmology Ltd Eye Surgery Center L L C	SD	Ambulatory Surgical Clinic/Center	$1.8M	$16.2K
Elizabeth Atchison	SD	Ophthalmology Physician	$1.7M	$0
Dakota Vision Center, LLC	SD	Optometrist	$0	$1.2M
Usc Ambulatory Surgical Center Prof LLC	SD	Ambulatory Surgical Clinic/Center	$1.1M	$44.2K
Avera Mckennan	SD	Physical Therapist	$0	$1M

Avera Mckennan — Billing Profile & Reimbursement Data

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Avera Mckennan — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center Fargo	ND	Family Medicine Physician	$0	$75.9M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Avera Mckennan	SD	Home Infusion Agency	$0	$6.7M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M
Avera St Marys	SD	Multi-Specialty Clinic/Center	$0	$4.6M
Avera Mckennan	SD	Emergency Medicine Physician	$0	$4.1M
Avera Mckennan	SD	General Acute Care Hospital	$0	$3.7M
Avera Mckennan	SD	Diagnostic Radiology Physician	$0	$3.3M
Avera Mckennan	SD	Hospitalist Physician	$0	$2.6M