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.

Pulmonary Associates Of Char LLC (NPI 1114124799)

Pulmonary Associates Of Char LLC is a pulmonary disease physician provider located in South Charleston, West Virginia. This profile covers 0 Medicare and 26 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	Pulmonary Associates Of Char LLC
Address	4619 Kanawha Ave., Sw
City	South Charleston
State	WV
ZIP	25309
Taxonomy	Pulmonary Disease Physician
NPI Enumerated	June 28, 2007

Payer Source	Total Paid
Medicaid	$5.5M
Medicare	$0

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	11,490	$130	$1.4M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	32,130	$40	$1.4M
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…	22,950	$50	$1.2M
71250	In this diagnostic procedure, the provider performs a computed tomography, or CT, examination of the thorax without using contrast material.	4,630	$70	$323.8K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	2,620	$110	$280.8K
94729	In this add on procedure, the provider tests the lungs’ diffusing capacity, the ability to exchange gases, moving oxygen into the bloodstream and letting in carbon dioxide from the bloodstream.	4,570	$40	$178.2K
94060	The spirometry test is performed with a spirometer. The instrument displays a graphical representation, known as a spirogram, of the test results. The basic forced volume vital capacity (FVC) test is…	4,150	$40	$145.2K
99204	The provider sees a new 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 provider…	1,550	$90	$144.2K
94727	The provider performs a pulmonary function test, or PFT, to assess the patient’s lung volumes using gas dilution or washout techniques that compare a known concentration of an inhaled gas with the…	1,750	$50	$78.6K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	220	$350	$76.4K

Showing 1–10 of 26

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

Pulmonary Associates Of Char LLC — 6 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

26 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	691	1,270	1,240	$30	$245K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	9	190	660	$40	$226.4K
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…	36	1,030	890	$50	$221K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	3	60	170	$130	$189.3K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	53	80	580	$60	$182K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	104	140	1,090	$20	$104.5K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	10	110	170	$100	$103.9K
99204	The provider sees a new 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 provider…	43	340	140	$90	$97.5K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	84	130	200	$70	$82.4K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	16	30	120	$290	$81.7K

Showing 1–10 of 26

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
James Perry	WV	Critical Care Medicine (Internal Medicine) Physician	$237.8K	$0
Ryan Waddell	WV	Pulmonary Disease Physician	$209.8K	$0
William Wade	WV	Critical Care Medicine (Internal Medicine) Physician	$200.4K	$0
Kevin Eggleston	WV	Critical Care Medicine (Internal Medicine) Physician	$195.2K	$0
Robby Keith	WV	Critical Care Medicine (Internal Medicine) Physician	$194.3K	$0
Phillip Cox	WV	Critical Care Medicine (Internal Medicine) Physician	$192.1K	$0
Tamejiro Takubo	WV	Critical Care Medicine (Internal Medicine) Physician	$119.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Urgent Care, Inc.- West Virginia	WV	Urgent Care Clinic/Center	$0	$66.9M
Herbert J. Thomas Memorial Hospital Association	WV	General Acute Care Hospital	$0	$26.1M
Mountaineer Family Medicine, Inc.	WV	Family Medicine Physician	$0	$19.5M
Ths Physician Partners Inc	WV	Internal Medicine Physician	$0	$9.2M
Appalachian Medical LLC	WV	Durable Medical Equipment & Medical Supplies	$0	$8M
Maccorkle Emergency Physicians PLLC	WV	Emergency Medicine Physician	$0	$4.4M
Patel & Patel Md Inc	WV	Obstetrics & Gynecology Physician	$0	$4M
Wecare Medical LLC	WV	Oxygen Equipment & Supplies (DME)	$0	$3.7M
Woman Care Clinic Inc	WV	Obstetrics & Gynecology Physician	$0	$3.5M
Lincoln County Primary Care Center, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$2.7M

Pulmonary Associates Of Char LLC — 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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