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

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

Monroe Medical Foundation, Inc. (NPI 1053499350)

Monroe Medical Foundation, Inc. is a general acute care hospital provider located in Tompkinsville, Kentucky. This profile covers 0 Medicare and 98 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	Monroe Medical Foundation, Inc.
Address	529 Capp Harlan Rd
City	Tompkinsville
State	KY
ZIP	42167
Taxonomy	General Acute Care Hospital
NPI Enumerated	November 2, 2006

Payer Source	Total Paid
Medicaid	$7.3M
Medicare	$0

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

98 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	8,840	$110	$1M
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.	1,620	$430	$704.8K
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.	8,250	$80	$618.8K
G0378	Hospital observation service, per hour	2,670	$230	$606.3K
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.	3,460	$120	$425.2K
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.	2,390	$180	$423.4K
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…	8,940	$40	$348.7K
G0379	Direct admission of patient for hospital observation care	2,700	$100	$267.2K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	3,300	$80	$257.5K
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.	1,330	$170	$220.1K

Showing 1–10 of 98

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Monroe Medical Foundation, Inc. — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

98 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	164	280	7,150	$150	$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.	148	240	4,710	$150	$2.6M
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.	123	280	5,700	$120	$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.	126	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	46	90	2,770	$190	$1.3M
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.	115	170	2,610	$250	$1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	90	110	8,390	$50	$749.1K
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.	130	180	2,960	$110	$672.4K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	92	100	5,870	$70	$670.3K
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…	28	30	2,090	$50	$662.1K

Showing 1–10 of 98

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Amjad Safvi	IL	Vascular & Interventional Radiology Physician	$568.9K	$765.4K
Vivek Sehgal	NJ	Diagnostic Radiology Physician	$281.4K	$265.1K
Matthew Hrastich	MO	Diagnostic Radiology Physician	$134.1K	$399.7K
Edmund Harris	NJ	Diagnostic Radiology Physician	$421.5K	$65.4K
Jerry Bean	KY	Family Medicine Physician	$52.9K	$108.7K
Stephen Eigles	WA	Diagnostic Radiology Physician	$131.9K	$0
Jason White	KY	Diagnostic Radiology Physician	$99.4K	$0
Victor Zirilli	KY	Diagnostic Radiology Physician	$82.7K	$0
Kevin Burner	KY	Diagnostic Radiology Physician	$79.2K	$0
Paul Bunn	KY	Emergency Medicine Physician	$18.8K	$0

Monroe Medical Foundation, Inc. — 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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