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

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

Metro Knoxville Hma LLC (NPI 1043292899)

Key Findings

Field	Value
Entity Type	Organization
Organization	Metro Knoxville Hma LLC
Address	7565 Dannaher Dr
City	Powell
State	TN
ZIP	37849
Taxonomy	General Acute Care Hospital
NPI Enumerated	November 17, 2005

Payer Source	Total Paid
Medicaid	$28.7M
Medicare	$0

METRO KNOXVILLE HMA LLC is effectively a single-payer Medicaid hospital in our dataset: there is no Medicare billing on file while total Medicaid revenue is $28.7M, indicating the provider’s fiscal footprint in public payer data is driven entirely by Medicaid activity. This concentration implies payer-network and reimbursement exposure is heavily skewed toward state Medicaid contracts rather than Medicare populations.

Revenue concentration is highly focused: the top three Medicaid codes by revenue account for 81.0% of the provider’s total Medicaid revenue, showing that a small set of services—predominantly emergency department evaluation-and-management and selected endoscopy procedures—drive the vast majority of billings. This degree of concentration suggests the hospital’s operational and revenue planning likely prioritizes those high-volume service lines.

Emergency department services dominate the revenue mix: 99284 ($11M, 39.2% of Medicaid revenue) and 99283 ($9.6M, 34.1%) together make up a very large share of Medicaid payments, and 99285 adds incremental volume. The code descriptions indicate the facility functions as a high-volume ED for moderate- and low-acuity E/M visits, positioning emergency care as a primary business line for its Medicaid population.

Procedure mix signals a meaningful endoscopy suite: 43239 generates $2.2M (7.8% of Medicaid revenue) and ranks as an extreme outlier in-state (96th percentile, rank #7 of 170). Along with colonoscopy codes like 45380 and 45385, this pattern points to substantial gastroenterology throughput and diagnostic/therapeutic endoscopy capacity relative to peers.

Competitive standing by code-level rank is mixed but notable: for core ED codes 99284 and 99283 the provider ranks in the 96th percentile statewide (ranks #27 and #26 respectively), a high-volume but described as 'typical, unremarkable' placement among many peers; for 43239 it is an 'extreme outlier' and therefore a clear market outlier in GI biopsy services. Several other codes (e.g., 96374, 96375, 36415, 96361) are listed as 'notably above typical' or high-percentile, indicating above-average ancillary and infusion activity for Medicaid patients.

Operational intensity is reflected in claim volumes and low per-claim payments for many lab and basic-service codes: very high claim counts appear for 85025 (57.8K claims), 80053 (52.3K claims), and 36415 (58.2K claims) with low average paid/claim amounts, consistent with routine laboratory and phlebotomy throughput supporting the ED and outpatient work. These high-volume, low-dollar services reinforce a throughput-oriented hospital model.

Tenure in national provider registries is long: NPI enumeration occurred on 2005-11-17 (~21 years ago). This longevity supports interpretation of current billing patterns as established service lines rather than very recent shifts in operations.

Given the absence of Medicare revenue, payer-mix risk should be a focus for payers and analysts: any changes in state Medicaid policy, reimbursement levels, or managed care networks could materially affect this provider because its entire recorded federal-payer revenue base is Medicaid-dominant. Contracting and utilization management efforts should center on ED flows and endoscopy utilization, which drive most Medicaid dollars here.

Medicaid: Complete Services Breakdown

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

138 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.	43,650	$250	$11M
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.	48,520	$200	$9.6M
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.	7,360	$300	$2.2M
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.	6,280	$280	$1.8M
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…	1,850	$340	$627.3K
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.	4,500	$120	$558.2K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	4,700	$80	$380.7K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	21,050	$10	$273.7K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	57,840	$1	$173.5K
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…	440	$370	$159.5K

Showing 1–10 of 138

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Metro Knoxville Hma LLC — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

138 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	18	60	1,340	$50	$1.1M
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.	27	630	510	$120	$1.1M
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.	26	610	570	$110	$884.4K
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.	76	570	640	$100	$637.8K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	86	100	400	$60	$524.7K
G0378	Hospital observation service, per hour	36	100	410	$210	$264K
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.	79	240	840	$20	$259.2K
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.	33	180	480	$90	$245.5K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	10	120	3,760	$30	$225K
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	6	30	130	$50	$221.4K

Showing 1–10 of 138

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mitchell Martin	TN	Hematology & Oncology Physician	$4.7M	$0
Yi Feng	TN	Hematology & Oncology Physician	$4M	$0
App Of East Tennessee Ed PLLC	TN	Emergency Medicine Physician	$0	$2.3M
Eye Surgery Center Of Knoxville, LLC	TN	Ambulatory Surgical Clinic/Center	$1M	$188.4K
Kevin Gallaher	TN	Ophthalmology Physician	$374.3K	$0
Tec North, LLC	TN	Ambulatory Surgical Clinic/Center	$366.6K	$0
Lee Congleton	TN	Urology Physician	$326.1K	$0
Christopher Ramsey	TN	Urology Physician	$299K	$0
Sean Delair	TN	Urology Physician	$208.9K	$0
Jared Spoons	TN	Internal Medicine Physician	$187.9K	$0

Metro Knoxville Hma LLC — Billing Profile & Reimbursement Data

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Metro Knoxville Hma LLC — 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

Nearby Providers

Frequently Asked Questions

References