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.

Lively Pediatrics, PLLC (NPI 1063006047)

Lively Pediatrics, PLLC is a pediatrics physician provider located in Princeton, West Virginia. This profile covers 0 Medicare and 41 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	Lively Pediatrics, PLLC
Address	608 New Hope Rd Ste 7
City	Princeton
State	WV
ZIP	24740
Taxonomy	Pediatrics Physician
NPI Enumerated	February 21, 2021

Payer Source	Total Paid
Medicaid	$872.1K
Medicare	$0

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

41 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…	6,180	$60	$346K
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…	1,630	$80	$126.9K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1,520	$70	$98.5K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1,490	$60	$90.6K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	2,080	$20	$35.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	2,800	$10	$30.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	330	$70	$22.5K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	1,490	$10	$19.4K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	610	$30	$15.8K
99203	The provider sees a new 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 provider…	250	$60	$15.6K

Showing 1–10 of 41

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

Lively Pediatrics, PLLC — 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

41 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	31	30	2,810	$100	$340.9K
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…	298	1,270	1,240	$30	$245K
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…	394	1,030	890	$50	$221K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	34	150	520	$50	$76.2K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	34	140	550	$50	$67.2K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	49	50	440	$30	$64.8K
99203	The provider sees a new 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 provider…	154	440	110	$60	$57.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	78	190	220	$50	$42.7K
94640	The provider administers oxygen under pressure or not under pressure to open obstructed air passages. He uses any of the listed devices to treat a patient with an acute obstruction of the airway that…	78	90	330	$40	$41.6K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	36	120	440	$10	$28.2K

Showing 1–10 of 41

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Voca Corporation Of West Virginia, Inc.	WV	Developmental Disabilities Clinic/Center	$0	$178.3M
Southern Highlands Community Mental Health Center, Inc.	WV	Community/Behavioral Health Agency	$0	$44.2M
Princeton Community Hospital Assn., Inc.	WV	General Acute Care Hospital	$0	$41M
Southern Highlands Community Mental Health Center, Inc.	WV	Counselor	$0	$22M
Princeton Community Hospital Assn Inc.	WV	Urology Physician	$0	$15.4M
Bluestone Health Association, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$12.1M
Princeton Rescue Squad Inc	WV	Land Ambulance	$1.1M	$10.4M
Foot And Ankle Clinic Of The Virginias Inc	WV	Podiatrist	$0	$5.5M
Bradley Hoffman	WV	Foot & Ankle Surgery Podiatrist	$4.9M	$0
Beautiful Minds Counseling Center	WV	Mental Health Counselor	$0	$4.1M

Lively Pediatrics, PLLC — Billing Profile & Reimbursement Data

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Lively Pediatrics, PLLC — 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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