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

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

Scl Health Montana (NPI 1083655997)

Field	Value
Entity Type	Organization
Organization	Scl Health Montana
Address	1233 N 30th St
City	Billings
State	MT
ZIP	59101
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 10, 2006

Payer Source	Total Paid
Medicaid	$13.5M
Medicare	$0

Key Findings

SCL HEALTH MONTANA reports no Medicare billing on file and $13.5M in lifetime Medicaid revenue, making its public payer footprint effectively single-payer Medicaid in the available data. The absence of Medicare activity means payer-mix analysis should focus on Medicaid rates, volumes, and any commercial/other payers not visible in these records.

Revenue is highly concentrated in a small set of emergency department E/M codes: the precomputed top-3 Medicaid codes account for 55.7% of the provider's total Medicaid revenue, driven by 99284, 99283, and 99285. This concentration indicates that more than half of Medicaid dollars flow from ED evaluation-and-management care rather than elective or routine outpatient services.

The code mix and volumes point to an ED- and acute-care–oriented operation: 99284 shows 61.7K claims and $2.8M revenue (22.4%), 99283 shows 68.4K claims and $2.3M revenue (17.8%), and 99285 shows 27.1K claims and $2M revenue (15.6%). The provider also reports 13.6K claims for G0378 (hospital observation service) with $230.8K revenue (1.8%), which supports the interpretation of substantial emergency-to-observation throughput.

Air ambulance and transport are material revenue contributors in absolute dollars — A0430 $1.6M (12.8%) and A0435 $1.4M (10.8%) plus additional rotary-wing lines A0431 $744.4K (5.9%) and A0436 $460.2K (3.6%) — but these codes rank in the middle of a very small statewide cohort (e.g., A0430 and A0435 rank #3 of 6, 60th percentile). In plain terms, air-transport generates meaningful Medicaid revenue for this provider, yet the state market for these codes is small so statewide rank is less informative about market dominance.

On competitive standing within Montana, SCL HEALTH MONTANA is a clear volume leader for core ED codes: 99284 ranks #1 of 75 (100th percentile; extreme outlier, far above typical state volume) and 99283 ranks #1 of 88 (100th percentile; extreme outlier, far above typical state volume), while 99285 ranks #3 of 55 (96th percentile; notably above typical state volume). These rankings indicate the provider is a dominant in-state ED provider by Medicaid claim volume and should be considered a major emergency-care node in payer network planning.

Beyond ED and transport, the provider reports notable volumes in high-frequency diagnostics and therapeutic procedures consistent with a full-service hospital: U0003 (SARS–CoV‑2 testing) shows 11.3K claims and $45.3K revenue (0.4%) and ranks #1 of 21 (100th percentile; notably above typical state volume); 96374 has 23.5K claims and $46.9K revenue (0.4%) and ranks #2 of 40 (97th percentile; notably above typical state volume); and 43239 has 2.9K claims and $279.4K revenue (2.2%) and ranks #2 of 29 (96th percentile; notably above typical state volume). This mix supports inpatient and procedure-capable capacity alongside ED throughput.

The provider's financial profile shows concentration risk tied to emergency services and transport lines: with the top three codes making up 55.7% of Medicaid revenue and several high-dollar air-transport codes contributing another sizable share, changes to Medicaid ED reimbursement, air-ambulance payment policy, or utilization management could materially affect overall revenue. Payers reviewing this profile should prioritize rate review and utilization trends for 99284, 99283, 99285 and the A043x series.

SCL HEALTH MONTANA has an NPI enumeration date of 2006-06-10 (~20 years ago), indicating an established presence and long operational tenure in the market; combined with its ED-volume dominance this suggests entrenched referral and regional emergency-service roles rather than a recent entrant or small clinic-scale operation. Tenure and the documented claim volumes support treating this entity as a major regional acute-care hospital for Medicaid strategy and network negotiations.

Medicaid: Complete Services Breakdown

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

415 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.	61,700	$50	$2.8M
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.	68,390	$30	$2.3M
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.	27,080	$70	$2M
A0430	Ambulance service, conventional air services, transport, one way (fixed wing)	1,100	$1,480	$1.6M
A0435	Fixed wing air mileage, per statute mile	1,110	$1,240	$1.4M
A0431	Ambulance service, conventional air services, transport, one way (rotary wing)	520	$1,430	$744.4K
A0436	Rotary wing air mileage, per statute mile	520	$880	$460.2K
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.	2,880	$100	$279.4K
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…	4,140	$60	$236K
G0378	Hospital observation service, per hour	13,580	$20	$230.8K

Showing 1–10 of 415

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Scl Health Montana — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

415 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
A0430	Ambulance service, conventional air services, transport, one way (fixed wing)	3	10	1,080	$1,310	$1.2M
A0435	Fixed wing air mileage, per statute mile	3	10	1,080	$1,000	$956.2K
A0431	Ambulance service, conventional air services, transport, one way (rotary wing)	2	10	520	$1,230	$770.5K
A0436	Rotary wing air mileage, per statute mile	2	10	520	$860	$541.2K
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.	3	60	2,160	$80	$526.7K
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.	1	80	2,770	$60	$471K
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	40	40	450	$160	$374.1K
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.	1	90	2,330	$40	$281.3K
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	23	30	240	$180	$270.7K
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…	86	530	580	$70	$224.6K

Showing 1–10 of 415

Related Providers

Other providers that share a Tax Identification Number (TIN) with Scl Health Montana, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Scl Health Medical Group - Billings LLC	MT	Clinic/Center	$0	$32.2M
Scl Health Montana	MT	Durable Medical Equipment & Medical Supplies	$0	$2.7M
St James Healthcare	MT	General Acute Care Hospital	$0	$1.8M
Douglas Debenham	IN	Radiation Oncology Physician	$1.8M	$0
Scl Health Montana	MT	Emergency Care Clinic/Center	$0	$867.8K
Scl Health Montana	MT	Oncology Clinic/Center	$0	$448.6K
Jared Heaton	UT	MOHS-Micrographic Surgery Physician	$447.3K	$0
Joshua Holstead	LA	Urology Physician	$389.5K	$0
Scl Health Montana	MT	Clinic/Center	$0	$385.9K
Catherine Brignoni	CA	Neurology Physician	$328.9K	$0

Nearby Providers

Other providers in the same ZIP code as Scl Health Montana, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Billings Clinic	MT	General Practice Physician	$0	$53.8M
Rimrock Foundation	MT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$44.9M
Residential Support Services	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$30.6M
Billings Public School District 2	MT	Local Education Agency (LEA)	$0	$19.2M
South Central Montana Regional Mental Health Center	MT	Clinic/Center	$0	$16.6M
Billings Clinic	MT	Emergency Care Clinic/Center	$0	$15.7M
Community Solutions Incorporated	MT	Clinical Medical Laboratory	$0	$14.1M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$10.8M
American Medical Response Ambulance Service Inc	MT	Ambulance	$2.1M	$6.7M
Yellowstone Pathology Institute, Inc.	MT	Clinical Medical Laboratory	$777.4K	$4.4M

Scl Health Montana — Billing Profile & Reimbursement Data

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Scl Health Montana — 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