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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

West Virginia Gastroenterology & Endoscopy (NPI 1023335213)

West Virginia Gastroenterology & Endoscopy is a gastroenterology physician provider located in Elkins, West Virginia. This profile covers 0 Medicare and 21 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	West Virginia Gastroenterology & Endoscopy
Address	55 Chenoweth Creek Rd
City	Elkins
State	WV
ZIP	26241
Taxonomy	Gastroenterology Physician
NPI Enumerated	April 27, 2010

Payer Source	Total Paid
Medicaid	$1M
Medicare	$0

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

21 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	8,310	$40	$307.3K
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.	1,950	$110	$208.9K
44377	The provider performs a visual examination of the upper gastrointestinal tract using a lighted endoscope. He examines the entire upper digestive tract from the esophagus to the ileum. If he finds…	690	$260	$178.5K
45390	The provider performs flexible colonoscopy along with excision of mucous membrane tissue using an endoscope.	680	$190	$131.6K
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…	2,200	$40	$85.8K
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…	510	$60	$28.8K
46946	The provider performs one of many techniques other than the rubber band technique to remove two or more hemorrhoids or groups. Hemorrhoids are small swollen vessels in the rectum or anus.	110	$260	$28.4K
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	80	$240	$20.4K
44376	The provider performs a visual examination of the upper gastrointestinal tract using a lighted endoscope. He examines the entire upper digestive tract from the esophagus to the ileum. If he finds…	70	$250	$17.4K
99439	The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…	1,570	$10	$12.6K

Showing 1–10 of 21

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

West Virginia Gastroenterology & Endoscopy — 2 of 17 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

21 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…	245	1,270	1,240	$30	$245K
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…	341	1,030	890	$50	$221K
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.	14	70	530	$170	$183.7K
44377	The provider performs a visual examination of the upper gastrointestinal tract using a lighted endoscope. He examines the entire upper digestive tract from the esophagus to the ileum. If he finds…	1	10	690	$260	$178.6K
45390	The provider performs flexible colonoscopy along with excision of mucous membrane tissue using an endoscope.	1	10	570	$180	$103.2K
99204	The provider sees a new 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 provider…	185	340	140	$90	$97.5K
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…	34	40	200	$220	$86.8K
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…	105	440	110	$60	$57.2K
87077	The lab analyst performs additional tests on a presumptively identified aerobic isolate to definitively, which means more specifically, identify the organism, such as to the level of species.	29	50	1,010	$20	$39K
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	16	30	90	$160	$30.8K

Showing 1–10 of 21

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Select In Home Services, Inc.	WV	Personal Care Attendant	$0	$25.7M
Davis Memorial Hospital	WV	General Acute Care Hospital	$0	$20.1M
Ems, Inc.	WV	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$17.6M
Mountaineer Home Care Services LLC	WV	In Home Supportive Care Agency	$0	$12.4M
Youth Health Service, Inc	WV	Community/Behavioral Health Agency	$0	$9.8M
Appalachian Community Health Center	WV	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$8.6M
Wendy Collins	WV	Homemaker	$0	$7.6M
Valley Health Care, Inc	WV	Federally Qualified Health Center (FQHC)	$0	$7.6M
Randolph County Court Emergency Squad	WV	Land Ambulance	$1M	$5.3M
Drs Wilson And Martino Of Elkins	WV	General Practice Dentistry	$0	$5.8M

West Virginia Gastroenterology & Endoscopy — Billing Profile & Reimbursement Data

Sign up for West Virginia Gastroenterology & Endoscopy — Billing Profile & Reimbursement Data policy alerts

West Virginia Gastroenterology & Endoscopy — Billing Profile & Reimbursement Data

Sign up for West Virginia Gastroenterology & Endoscopy — Billing Profile & Reimbursement Data policy alerts

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
Nitesh Ratnakar	WV	Gastroenterology Physician	$270.9K	$0
Tiffany Carr	WV	Family Nurse Practitioner	$93K	$0