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NPI 1124017637 · Racine, WV · Ambulance
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Boone County Ambulance Authority is a ambulance provider located in Racine, West Virginia. This profile covers 6 Medicare and 7 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $6M |
| Medicare | $543.6K |
BOONE COUNTY AMBULANCE AUTHORITY’s billing profile is concentrated in ambulance ground-transport services: the top Medicare and Medicaid revenue drivers are A0425 (ground mileage), A0427 (ALS 1 emergency), and A0429 (BLS emergency), reflecting a primarily transport-focused EMS operation rather than clinic- or procedure-based services. This mix indicates routine emergency and mileage billing is the core service line for both payers, with specialty transport and non-transport codes playing much smaller roles.
Medicare revenue is highly concentrated in three codes: A0425 accounts for 38.1% of Medicare revenue, A0427 20.9%, and A0429 19.9%; together the precomputed top-3 share is 79.0% of this provider's total Medicare revenue. These percentages show the provider’s Medicare activity is dominated by mileage and emergency ALS/BLS transports, leaving limited diversification across other Medicare codes.
Medicaid revenue shows an even stronger concentration in the same transport codes: A0425 represents 41.5% of Medicaid revenue, A0427 26.2%, and A0429 20.8%, with the precomputed top-3 share at 88.5% of total Medicaid revenue. This indicates that Medicaid payments are overwhelmingly coming from the same core transport services, underscoring dependence on mileage and emergency transport reimbursement from the state program.
The payer mix is heavily weighted toward Medicaid in scale: lifetime Medicaid revenue is $6M compared with total Medicare revenue of $543.6K, so Medicaid represents the dominant revenue stream for this provider. This asymmetry suggests the provider’s financial and network importance is primarily within the state Medicaid market rather than Medicare.
Competitive standing on Medicare shows respectable national placement for mileage and emergency transports but is characterized as typical rather than an extreme outlier: A0425 ranks #693 of 8934 (92th percentile), A0427 ranks #2200 of 6841 (68th percentile), and A0429 ranks #1507 of 7808 (81th percentile) — each labeled as "typical, unremarkable volume" in the comparison data. Those percentiles indicate above-average activity on some codes nationally but still within expected operational norms for ambulance providers.
State-level competitive standing on Medicaid is similarly solid but not dominant: A0425 ranks #23 of 137 (84th percentile), A0427 ranks #15 of 96 (85th percentile), and A0429 ranks #20 of 113 (83th percentile), with each code described as "typical, unremarkable volume." In-state positioning places the provider among the more active Medicaid transport vendors in West Virginia, but the descriptors imply it is not an extreme outlier or monopolistic provider.
Specialty care and non-transport services are present but limited: Medicare A0434 (Specialty care transport) contributes $32.1K or 5.7% of Medicare revenue and ranks #253 of 591 (57th percentile), indicating a modest SCT capability on the Medicare side. On Medicaid, A0434 appears only as 17 claims with $8.6K revenue and is ranked #5 of 5 (0th percentile), signaling that specialty care transport is rarely billed to Medicaid and is not a major revenue source.
The provider has established tenure in the national registry, with NPI enumeration on 2005-10-18 (~21 years ago), suggesting long-term operation in the market. Combined with the heavy Medicaid revenue concentration and typical percentile rankings, this tenure supports interpreting BOONE COUNTY AMBULANCE AUTHORITY as a steady, locally important ambulance operator whose business is concentrated on routine mileage and emergency ALS/BLS transports rather than diversified services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 30,460 | $10 | $213.2K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 330 | $360 | $117K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 370 | $300 | $111.4K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 440 | $170 | $75K |
| A0434 | Specialty care transport (sct) | 50 | $620 | $32.1K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 50 | $230 | $10.3K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 17,030 | $150 | $2.5M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 5,720 | $270 | $1.6M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 5,280 | $240 | $1.2M |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 4,530 | $120 | $552.8K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 470 | $230 | $110.4K |
| A0998 | Ambulance response and treatment, no transport | 290 | $50 | $13.1K |
| A0434 | Specialty care transport (sct) | 20 | $510 | $8.6K |
How this provider's Medicaid billing volume and revenue compare to other West Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. West Virginia median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 23 | 140 | 2,710 | $100 | $955.9K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 33 | 70 | 3,360 | $110 | $830K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 15 | 100 | 840 | $260 | $730.3K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 20 | 110 | 950 | $220 | $703.7K |
| A0434 | Specialty care transport (sct) | 5 | 10 | 210 | $450 | $212.3K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 16 | 30 | 530 | $190 | $203K |
| A0998 | Ambulance response and treatment, no transport | 8 | 20 | 230 | $50 | $35.1K |
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