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

Why is the Medicaid comparison limited to 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. 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.

Carilion Medical Center (NPI 1033102942)

Field	Value
Entity Type	Organization
Organization	Carilion Medical Center
Address	1906 Belleview Ave Se
City	Roanoke
State	VA
ZIP	24014
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 25, 2005

Payer Source	Total Paid
Medicaid	$124.7M
Medicare	$0

Key Findings

CARILION MEDICAL CENTER shows no Medicare billing on file while reporting $124.7M in lifetime Medicaid revenue, indicating the provider’s publicly visible fee-for-service footprint in these datasets is effectively single-payer (Medicaid) rather than split between Medicare and Medicaid. This payer mix should be considered when benchmarking revenue and utilization against typical acute-care hospitals that bill both payers.

Revenue concentration is high: the top three Medicaid codes (99284, 99283, 99285) together account for 37.0% of the provider’s total Medicaid revenue, signaling that emergency department evaluation-and-management services are the primary revenue drivers in the Medicaid population. Individually, 99284 and 99283 each generate $10.3M (13.2% and 13.1% of Medicaid revenue respectively) while 99285 contributes $8.4M (10.8%).

The procedure and service mix points to a high-volume acute-care hospital with a busy emergency department plus substantial procedural and diagnostic capacity: frequent ED E/M codes (99284, 99283, 99285, 99282), large-volume IV infusion services (96361 $7.2M, 96366 $1.6M), endoscopy/biopsy activity (43239 $3.2M), and imaging/cardiac diagnostics (74177 $2.8M, 93306 $2.3M). These patterns are consistent with combined emergency, inpatient, outpatient procedural, and ancillary service lines (radiology, endoscopy, cardiology, infusion, and rehab) driving Medicaid revenue.

Competitive standing within Virginia’s Medicaid market is strong for emergency care: 99284 ranks #24 of 620 providers (96th percentile; notably above typical state volume), 99283 ranks #28 of 626 (96th percentile; notably above typical state volume), and 99285 ranks #18 of 340 (95th percentile; typical, unremarkable volume). These ranks indicate the hospital is a major regional ED provider by Medicaid volume, even if other clinical lines vary in relative dominance.

CARILION is an extreme outlier or near-outlier for several specialized procedural codes, signaling concentrated expertise or referral flow in particular services. Notably, 43239 (endoscopic biopsy) ranks #3 of 146 (99th percentile; extreme outlier), 64493 (lumbar/sacral facet injection) ranks #1 of 29 (100th percentile; extreme outlier), 62323 (lumbar epidural injection) ranks #1 of 40 (100th percentile; extreme outlier), and 99220 ranks #1 of 39 (100th percentile; extreme outlier).

Interventional pain, spine injections, and procedural specialties are clearly material to the provider’s Medicaid business: 64493 ($1.8M, 2.4% of Medicaid revenue) and 62323 ($1.3M, 1.6% of Medicaid revenue) both sit at the top of statewide rankings, while related injection codes such as 64483 ($1.4M, 1.8%) rank highly (#2 of 34, 97th percentile). This concentration suggests a notable institutional capability or referral hub for spine/pain procedures within the state Medicaid network.

Advanced imaging and oncology/therapy capacity are present in the Medicaid mix, supporting that CARILION provides higher-acuity diagnostic and treatment services beyond routine ED care. Examples include 70553 ($1.8M, 2.3% of Medicaid revenue; rank #6 of 87, 94th percentile), 78815 ($1.3M, 1.6% of Medicaid revenue; rank #6 of 36, 86th percentile), and 77386 ($1.7M, 2.2% of Medicaid revenue; rank #2 of 8, 86th percentile), consistent with in-house MRI, PET/CT, and IMRT delivery.

The provider’s NPI tenure (NPI enumerated 2005-08-25, ~21 years ago) indicates an established institutional presence in Roanoke, VA; coupled with the code-level outlier positions and high ED volumes, the data support an interpretation of CARILION as a long-standing, high-volume regional acute-care center that concentrates Medicaid revenue in ED services and a set of high-volume procedural specialties.

Medicaid: Complete Services Breakdown

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

589 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	58,520	$180	$10.3M
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.	58,240	$180	$10.3M
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.	47,930	$180	$8.4M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	24,710	$290	$7.2M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	3,370	$1,250	$4.2M
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.	5,710	$560	$3.2M
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.	13,160	$210	$2.8M
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…	49,700	$50	$2.7M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	15,290	$160	$2.5M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	7,250	$320	$2.3M

Showing 1–10 of 589

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Carilion Medical Center — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

589 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	10	90	9,030	$280	$3.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	5	70	3,200	$110	$2.8M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	7	10	800	$1,530	$2.1M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	4	30	600	$1,370	$1.7M
44970	Laparoscopy, surgical, appendectomy	4	10	40	$4,520	$1.6M
59899	Use 59899 to report procedures in maternity care and delivery, other than those that employ laparoscopy, that do not have a specific code.	2	10	1,440	$780	$1.4M
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.	18	340	160	$130	$1.3M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	2	10	450	$540	$1.3M
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	2	10	260	$1,660	$1.3M
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.	28	630	90	$140	$1.1M

Showing 1–10 of 589

Related Providers

Other providers that share a Tax Identification Number (TIN) with Carilion Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carilion Medical Center	VA	Multi-Specialty Clinic/Center	$0	$73.4M
Carilion New River Valley Medical Center	VA	General Acute Care Hospital	$0	$32.4M
Carilion Healthcare Corporation	VA	Multi-Specialty Clinic/Center	$0	$26.1M
Carilion Franklin Memorial Hospital	VA	General Acute Care Hospital	$0	$18.4M
Carilion Medical Center	VA	Emergency Medicine Physician	$0	$18.1M
Jefferson Radiology, PC	CT	Diagnostic Radiology Physician	$0	$14M
Stonewall Jackson Memorial Hospital Company	WV	Rural Acute Care Hospital	$0	$13M
Carilion Rockbridge Community Hospital	VA	Critical Access Hospital	$0	$11.8M
Carilion Emergency Services, Inc.	VA	Urgent Care Clinic/Center	$0	$11.1M
Carilion Medical Center	VA	Home Health Agency	$0	$7.3M

Nearby Providers

Other providers in the same ZIP code as Carilion Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carilion Clinic Patient Transportation, LLC	VA	Air Ambulance	$2.6M	$6.1M
Quest Diagnostics Clinical Laboratories Inc	VA	Clinical Medical Laboratory	$3.9M	$186.2K
Mark Kochenderfer	VA	Hematology & Oncology Physician	$2.5M	$0
Amanda Gillespie-twardy	VA	Hematology & Oncology Physician	$1.9M	$0
Suzan Merten	VA	Hematology & Oncology Physician	$1.8M	$90
Padmaja Mallidi	VA	Hematology & Oncology Physician	$1.7M	$0
Fairlawn Surgery Center, LLC	VA	Ambulatory Surgical Clinic/Center	$997K	$572.4K
Donald Vile	VA	Hematology & Oncology Physician	$1.4M	$0
Joshua Morales	VA	Hematology & Oncology Physician	$886.1K	$0
Matthew Skelton	VA	Hematology & Oncology Physician	$821.2K	$90

Carilion Medical Center — 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