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

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

St. Cloud Hospital (NPI 1043269798)

Key Findings

Field	Value
Entity Type	Organization
Organization	St. Cloud Hospital
Address	1406 6th Ave North
City	Saint Cloud
State	MN
ZIP	56303
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 9, 2006

Payer Source	Total Paid
Medicaid	$53.4M
Medicare	$0

ST. CLOUD HOSPITAL has no Medicare billing on file and is effectively a Medicaid-centric provider, with Total Medicaid revenue reported as $53.4M. The absence of Medicare revenue indicates the facility operates with a single-payer concentration in the claims data available here rather than a mixed Medicare/Medicaid outpatient or inpatient billing profile.

Revenue is highly concentrated: the precomputed top three Medicaid codes — 99283, H0035, and 99282 — together account for 50.1% of this provider's total Medicaid revenue. Individually those codes are reported as 99283: $9.2M (19.8%), H0035: $8.2M (17.8%), and 99282: $5.8M (12.5%), showing a small set of services driving the majority of Medicaid dollars.

The code mix points to a combined emergency department and behavioral-health partial hospitalization business model. High volumes for ED E/M codes (99283 with 53.6K claims and 99282 with 43.3K claims) together with H0035 (24.8K claims for mental health partial hospitalization) suggest routine throughput in both ED acute care and structured outpatient psychiatric treatment.

ST. CLOUD is a dominant in-state filer for several ED visit levels, particularly for straightforward and low-acuity ED encounters: 99282 ranks #1 of 146 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code) and 99281 ranks #1 of 30 providers in-state (100th percentile; extreme outlier). 99283 is also high-volume (53.6K claims) and ranks #10 of 218 (96th percentile; typical, unremarkable volume), indicating unusually large ED visit volumes relative to most Minnesota peers.

Behavioral health services appear to be a material service line beyond the ED: H0035 (mental health partial hospitalization) generated $8.2M in revenue, ranks #2 of 13 providers in-state (92th percentile; typical, unremarkable volume), and 90834 psychotherapy appears with 19.1K claims and $1.2M revenue (95th percentile; typical, unremarkable volume). This combination of high-volume partial hospitalization and psychotherapy claims signals an established outpatient behavioral health program that contributes meaningfully to Medicaid revenue.

The hospital also functions as a major maternal-fetal imaging and obstetrics hub in-state: 76811 (detailed transabdominal fetal ultrasound) produced $1.2M (ranks #1 of 35 providers in-state, 100th percentile; extreme outlier, far above typical state volume) and related follow-up ultrasound 76816 is also high-volume (11.2K claims, $702.8K revenue, 96th percentile; extreme outlier). These ranks indicate the provider performs substantially more fetal imaging under Medicaid than most peers in Minnesota.

Ancillary and therapy services are significant and broad-based across the outpatient episode of care: high claim counts and above-typical state volume appear for therapeutic exercise and functional activity codes (97530: 43.4K claims, $1.9M revenue, 97th percentile; 97110: 32.4K claims, $907.4K revenue, 97th percentile), IV infusion/administration (96361: 8.5K claims, $1.4M revenue, 96th percentile), and remote device monitoring (93296: 12.3K claims, $393.7K revenue, ranks #1 of 20, 100th percentile; extreme outlier). This mix suggests a comprehensive outpatient service portfolio including rehab, infusion, and device monitoring under Medicaid.

ST. CLOUD HOSPITAL's NPI was enumerated on 2006-05-09 (~20 years ago), indicating a long-tenured presence in the market. That tenure, combined with multiple 100th-percentile and extreme-outlier rankings across ED, obstetric imaging, and device monitoring codes, supports the interpretation of an established regional hub for both acute ED care and several specialty outpatient services under Medicaid.

Medicaid: Complete Services Breakdown

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

213 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.	53,560	$170	$9.2M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	24,780	$330	$8.2M
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.	43,320	$130	$5.8M
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…	61,570	$80	$4.6M
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…	40,700	$50	$2.1M
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.	43,360	$40	$1.9M
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.	8,510	$160	$1.4M
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	11,950	$100	$1.2M
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…	19,100	$60	$1.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	17,780	$60	$1.1M

Showing 1–10 of 213

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Minnesota Distribution

St. Cloud Hospital — 15 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Minnesota

Full comparison — all codes billed, vs. Minnesota median

213 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	28	80	6,550	$80	$4.4M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	2	10	1,690	$300	$2.4M
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.	95	160	580	$170	$1.8M
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.	87	210	980	$140	$1.7M
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.	10	220	1,730	$120	$1.3M
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…	23	120	400	$60	$685.8K
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…	17	1,180	1,150	$80	$605.7K
90870	The provider applies an electric current to the patient's brain for the purpose of producing a seizure or series of seizures to alleviate symptoms of various mental disorders.	9	20	650	$190	$566.5K
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…	9	110	1,880	$50	$564.6K
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.	62	100	510	$40	$560.8K

Showing 1–10 of 213

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St. Cloud Hospital	MN	Substance Use Disorder Rehabilitation Hospital Unit	$0	$5.2M
Minneapolis Clinic Of Neurology, Ltd	MN	Neurology Physician	$0	$5M
St. Cloud Hospital	MN	Clinic/Center	$0	$4.4M
Sue Mandell	WA	Radiation Oncology Physician	$302.2K	$0
Hani Alkhatib	MN	Hematology & Oncology Physician	$173.1K	$0
Ramesh Kumar Tentu	MN	Hospitalist Physician	$171.8K	$0
Bradley Stish	MN	Radiation Oncology Physician	$171.7K	$0
John Dvorak	MN	Ophthalmology Physician	$160.8K	$0
Karan Shah	IL	Radiation Oncology Physician	$156.9K	$0
Christopher Miller	MN	Radiation Oncology Physician	$136.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Central Minnesota Mental Health Center	MN	Mental Health Counselor	$0	$36.2M
Centracare Clinic	MN	Multi-Specialty Clinic/Center	$0	$20.8M
Centracare Clinic	MN	Multi-Specialty Clinic/Center	$0	$19.3M
Eye Kraft Optical, Inc	MN	Eyewear Supplier	$0	$17.7M
Northway Academy, Inc.	MN	Developmental Disabilities Clinic/Center	$0	$14.4M
Koala Dental Care, LLC	MN	Pediatric Dentistry	$0	$11.3M
Centracare Health Systems	MN	Clinical Medical Laboratory	$1.2M	$9.4M
Centracare Health System	MN	Clinical Medical Laboratory	$345.1K	$9.1M
St. Cloud Area School District 742	MN	Local Education Agency (LEA)	$0	$9.3M
Centracare Clinic	MN	Multi-Specialty Clinic/Center	$0	$6.9M

St. Cloud Hospital — Billing Profile & Reimbursement Data

Sign up for St. Cloud Hospital — Billing Profile & Reimbursement Data policy alerts

St. Cloud Hospital — Billing Profile & Reimbursement Data

Sign up for St. Cloud Hospital — Billing Profile & Reimbursement Data policy alerts

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