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.

Fall River Health Services (NPI 1043228810)

Fall River Health Services is a rural health clinic/center provider located in Hot Springs, South Dakota. This profile covers 0 Medicare and 14 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	Fall River Health Services
Address	1201 Highway 71 South
City	Hot Springs
State	SD
ZIP	57747
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	August 4, 2006

Payer Source	Total Paid
Medicaid	$1.4M
Medicare	$0

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

14 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…	6,060	$90	$521.5K
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…	6,240	$80	$499.4K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	1,520	$70	$110.6K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	2,000	$60	$109.9K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	470	$90	$41.9K
99308	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider…	690	$40	$27.5K
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…	210	$90	$19.3K
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…	150	$80	$10.9K
90834	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…	50	$100	$5.3K
W0037	N/A	1,200	$1	$3.6K

Showing 1–10 of 14

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

Fall River Health Services — 0 of 14 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

14 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…	62	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…	28	260	860	$80	$222.6K
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…	130	190	430	$90	$154.1K
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…	14	20	30	$90	$144.2K
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…	32	70	130	$100	$99K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	28	160	210	$120	$97.4K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	26	30	150	$40	$72.6K
90834	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…	62	80	200	$60	$53.9K
W0037	N/A	66	160	690	$20	$50.1K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	5	20	100	$40	$26.9K

Showing 1–10 of 14

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Fall River Health Services	SD	Critical Access Hospital	$0	$303.3K
Lauren Buyan	SD	Emergency Medicine Physician	$114.9K	$0
John Misdary	SD	Emergency Medicine Physician	$114K	$0
Alexander Brech	SD	Emergency Medicine Physician	$114K	$0
John Hill	SD	Emergency Medicine Physician	$113.3K	$0
Michael Frost	SD	Emergency Medicine Physician	$110.3K	$0
Jed Christensen	SD	Emergency Medicine Physician	$109.2K	$0
Kirsten Busse	SD	Emergency Medicine Physician	$107.6K	$0
Brook Eide	SD	Emergency Medicine Physician	$88.4K	$0
Patrick Tibbles	SD	Emergency Medicine Physician	$80.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Monument Health Network, Inc.	SD	Rural Health Clinic/Center	$0	$324.1K
Hot Springs Ambulance Service	SD	Land Ambulance	$264.2K	$53.5K
Wilkinson Vision, Inc	SD	Optometrist	$0	$195.2K
Cascade Chiropractic Of South Dakota	SD	Chiropractor	$0	$147.1K
Massa Dental Offices, PC	SD	General Practice Dentistry	$0	$132.3K
Dallas Wilkinson	SD	Optometrist	$70.1K	$0
Catherine Wilson	SD	Certified Registered Nurse Anesthetist	$52.1K	$0
Brad Fischer	SD	Physical Therapist	$51.9K	$0
Shannon Deboer	SD	Chiropractor	$50.1K	$0
Dakotamart Inc	SD	Community/Retail Pharmacy	$30.9K	$0

Fall River Health Services — Billing Profile & Reimbursement Data

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Fall River Health Services — 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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