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

Why is the Medicaid comparison limited to Montana 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. Montana (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.

Providence Health & Services Mt (NPI 1023032588)

Providence Health & Services Mt is a general acute care hospital provider located in Missoula, Montana. This profile covers 0 Medicare and 304 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	Providence Health & Services Mt
Address	500 W Broadway St
City	Missoula
State	MT
ZIP	59802
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 27, 2006

Payer Source	Total Paid
Medicaid	$2.4M
Medicare	$0

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

304 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	27,410	$10	$328.9K
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.	23,300	$10	$302.9K
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.	16,620	$20	$249.4K
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.	6,180	$20	$117.4K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	5,700	$20	$97K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	9,830	$10	$68.8K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	9,140	$10	$64K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	1,380	$50	$62.1K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	1,560	$40	$59.2K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	53,660	$1	$53.7K

Showing 1–10 of 304

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Providence Health & Services Mt — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

304 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	8	60	2,160	$80	$526.7K
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.	6	80	2,770	$60	$471K
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.	5	90	2,330	$40	$281.3K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	111	150	2,760	$40	$224.3K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	13	30	3,780	$40	$222.6K
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.	104	200	1,110	$60	$207.2K
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…	17	30	640	$90	$188.1K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	14	20	970	$100	$148K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	7	20	190	$280	$137.5K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	5	10	260	$260	$130.4K

Showing 1–10 of 304

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Consumer Direct District Of Columbia	MT	In Home Supportive Care Agency	$0	$393.2M
Youth Homes	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$9.7M
Western Montana Clinic PC	MT	Multi-Specialty Clinic/Center	$0	$8.7M
Providence Surgery Center	MT	Ambulatory Surgical Clinic/Center	$1.6M	$3.5M
Partnership For Children	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$4.7M
Gary Wingfield	MT	Assisted Living Facility	$0	$4.7M
Western Montana Clinic PC	MT	Clinical Medical Laboratory	$668.9K	$1.7M
Blue Mountain Clinic, Inc.	MT	Family Medicine Physician	$0	$1.4M
Youth Homes	MT	Community/Behavioral Health Agency	$0	$972.2K
Partnership For Children	MT	Community/Behavioral Health Agency	$0	$937.8K

Providence Health & Services Mt — Billing Profile & Reimbursement Data

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Providence Health & Services Mt — Billing Profile & Reimbursement Data

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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
Providence Health & Services Mt	MT	Emergency Medicine Physician	$0	$8.2M
Providence Health & Services Mt	MT	Family Medicine Physician	$0	$5.7M
Providence Health & Services Mt	MT	Family Medicine Physician	$0	$4.9M
Scott Guess	MT	Ophthalmology Physician	$2.7M	$72.4K
Melody Nelsen	MT	Rheumatology Physician	$2M	$0
Providence Health & Services Mt	MT	Psychiatric/Mental Health Nurse Practitioner	$0	$1.8M
Rebecca Belsom	MT	Rheumatology Physician	$1.4M	$0
Rebecca Danforth	MT	Rheumatology Physician	$396K	$0
Providence Health & Services Mt	MT	Pulmonary Disease Physician	$0	$394K
Providence Health & Services Mt	MT	Medical Oncology Physician	$0	$392.7K