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 Health Care Cooperative Inc (NPI 1043778319)

Key Findings

Field	Value
Entity Type	Organization
Organization	West Virginia Health Care Cooperative Inc
Address	400 Fairview Heights Rd
City	Summersville
State	WV
ZIP	26651
Taxonomy	Critical Access Hospital
NPI Enumerated	March 6, 2019

Payer Source	Total Paid
Medicaid	$19.2M
Medicare	$0

This provider is effectively single‑payer in the available data: there is no Medicare billing on file while Medicaid revenue totals $19.2M, indicating Medicaid is the dominant (and only reported) public payer relationship for this entity. The absence of Medicare claims suggests either no Medicare billing activity or that services to Medicare beneficiaries are routed through another billing entity; the record should be treated as Medicaid‑centric for payer‑strategy work.

Revenue is highly concentrated in emergency department evaluation-and-management codes: 99284 generated $3.3M (21.5% of Medicaid revenue), 99285 generated $2.3M (15.3%), and 99283 generated $2.0M (13.2%); the three codes together account for 50.1% of the provider's Medicaid revenue. This concentration signals that ED visits are the primary revenue driver and should be the focus for utilization management, contracting, or capacity planning.

The code mix and high claim counts point to a critical‑access hospital functioning as an acute care and emergency hub: large volumes for ED E/M codes (99284/99285/99283) plus high counts of basic labs and monitoring such as 85025 (33.4K claims, $434.6K revenue) and 93005 (8.9K claims, $355.7K revenue) support a pattern of front‑line emergency and diagnostic throughput. Significant use of imaging and advanced diagnostics — 74177 ($594.3K), 74176 ($532.8K), 70450 ($469.4K) and 93306 ($519.4K) — further indicates on‑site CT and cardiac imaging capacity consistent with an acute care CAH.

Clinical supply and procedure mix shows routine inpatient/ED supportive services and IV therapy: infusion and injection codes 96374 (8.1K claims, $552.8K revenue), 96375 (7.7K claims, $252.8K), 96365 (4.4K claims, $222.5K) and 96372 (5.1K claims, $164.6K) reflect frequent IV/IM medication administration workflows typical of emergency and observation care. Combined with lab panels like 80053 (28.5K claims, $1.2M revenue) and point‑of‑care PCR testing 87637 (3.1K claims, $290K), the profile is consistent with same‑day acute evaluation and treatment.

Competitive standing within the state is generally modest-to‑above average but described as typical for most top codes: 99284 ranks #24 of 168 (86th percentile), 99285 ranks #24 of 132 (82nd percentile), and 99283 ranks #25 of 163 (85th percentile) — each entry is characterized in the source as "typical, unremarkable volume for this code," indicating the provider is not an outlier but performs at or above the median peer activity. Several diagnostic and lab codes also sit in the upper percentiles (for example, 85025 at the 88th percentile and 80053 at the 84th percentile), reinforcing that the facility is a reliable regional provider of diagnostics rather than a dominant statewide system.

Operational risk/attention areas for payers: because half the Medicaid revenue is concentrated in three ED E/M codes, any changes to ED utilization, case‑mix, or audits of E/M documentation could materially affect the provider's revenues. Payers and network managers should prioritize review of ED throughput, observation vs. admission coding patterns, and alignment of payment arrangements to ED volume rather than broad inpatient DRG exposure.

Tenure and billing footprint: the provider's NPI was enumerated on 2019-03-06 (~7 years ago), indicating a relatively recent enrollment as a billing entity compared with longer‑standing hospitals. This recency, combined with a Medicaid‑only billing profile, may reflect a smaller, locally focused CAH that has developed Medicaid relationships first or primarily.

Medicaid: Complete Services Breakdown

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

235 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.	19,800	$170	$3.3M
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.	9,640	$240	$2.3M
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.	15,650	$130	$2M
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	28,480	$40	$1.2M
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.	1,940	$310	$594.3K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	8,130	$70	$552.8K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	2,020	$260	$532.8K
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…	2,510	$210	$519.4K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	2,760	$170	$469.4K
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…	33,430	$10	$434.6K

Showing 1–10 of 235

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 Health Care Cooperative Inc — 0 of 25 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

235 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	24	130	2,090	$210	$1.5M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	38	40	820	$30	$1.2M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	38	40	820	$30	$1.2M
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.	24	170	3,350	$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.	25	160	3,690	$80	$714.8K
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.	31	80	950	$140	$559.5K
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.	51	110	2,080	$50	$537.1K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	30	50	800	$70	$504.4K
G0378	Hospital observation service, per hour	21	50	940	$140	$363K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	19	110	5,530	$20	$344.8K

Showing 1–10 of 235

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Summersville Regional Medical Center	WV	Critical Access Hospital	$0	$3.4M
West Virginia Health Care Cooperative Inc	WV	Hospitalist Physician	$0	$3.1M
West Virginia Health Care Cooperative Inc	WV	Rural Health Clinic/Center	$0	$1.6M
Salman Osman	WV	Hematology & Oncology Physician	$146.1K	$0
Charles Moore	WV	Ophthalmology Physician	$145.3K	$0
Bethany Pellegrino	WV	Nephrology Physician	$126.5K	$0
Richard Trenbath	WV	Family Medicine Physician	$75.3K	$0
Jonathan Stanley	WV	Infectious Disease Physician	$73.7K	$0
Yaoxian Ding	RI	Anatomic Pathology & Clinical Pathology Physician	$36.9K	$22.7K
Howard Lafferty	WV	Family Medicine Physician	$57.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Summersville Pediatrics Inc.	WV	Specialist	$0	$12M
Nicholas Community Action Partnership, Inc.	WV	Point of Service	$0	$6.2M
Nicholas Pharmacy Inc	WV	Oxygen Equipment & Supplies (DME)	$0	$2.2M
Nicholas Community Action Partnership, Inc.	WV	Home Health Agency	$0	$2M
Nicholas Emergency Group, PLLC	WV	Emergency Medicine Physician	$0	$1.6M
New River Health Association, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$1.4M
New River Health Association, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$1.3M
Katherine Wooton	WV	Dentist	$0	$1.2M
Mountain Ridge Dialysis LLC	WV	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$845.4K
Stephen Young	WV	Physical Therapist	$71.1K	$0

West Virginia Health Care Cooperative Inc — 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