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

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

Wellmont Health System (NPI 1124058615)

Key Findings

Field	Value
Entity Type	Organization
Organization	Wellmont Health System
Address	1 Medical Park Blvd
City	Bristol
State	TN
ZIP	37620
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 3, 2006

Payer Source	Total Paid
Medicaid	$27.3M
Medicare	$0

WELLMONT HEALTH SYSTEM reports no Medicare billing on file and $27.3M in lifetime Medicaid revenue, making it effectively a single-payer (Medicaid) billing profile in the available data. Analysts should treat Medicaid as the primary payer when assessing this facility’s revenue and utilization patterns because there is no Medicare activity to compare against.

Revenue is highly concentrated in emergency department evaluation-and-management services: the precomputed top three Medicaid codes (99284, 99285, 99283) account for 61.6% of the provider’s total Medicaid revenue. Those three codes alone generate $8.5M (34.5%), $3.9M (15.9%), and $2.8M (11.2%) respectively, indicating that a majority of Medicaid dollars flow through ED encounters.

The code mix indicates an ED- and observation-centric operation supported by infusion and diagnostic services. High Medicaid revenue for 99284/99285/99283 combined with $1.6M from 96361 (6.6%) and notable CT volumes such as 74177 ($913K, 3.7%) and 70450 ($730K, 3.0%) points to frequent acute presentations managed with IV fluids/infusions and advanced imaging.

Competitive standing on core ED codes is solid but characterized in the source as routine: 99284 ranks #28 of 625 in-state (96th percentile; typical, unremarkable volume for this code), 99285 ranks #32 of 565 (95th percentile; typical, unremarkable volume), and 99283 ranks #58 of 611 (91th percentile; typical, unremarkable volume). In plain terms, the hospital appears near the upper end of state providers by rank for these ED codes, but the dataset describes these volumes as not exceptional for hospitals of this type.

The provider shows several Medicaid code-level outliers that signal above-typical state activity in specific service lines. G0378 (hospital observation service) is #5 of 96 (96th percentile; notably above typical state volume), 97602 (debridement) is #1 of 5 (100th percentile; notably above typical state volume), and 94640 (oxygen administration) is #6 of 209 (98th percentile; notably above typical state volume), indicating relatively greater emphasis or volume in observation care, wound debridement, and acute respiratory interventions.

Beyond ED and observation activity, the hospital bills materially for outpatient therapy and procedural support: 97110 (therapeutic exercise) accounts for $450.8K (1.8%) and 97530 (therapeutic activities) $293.2K (1.2%), showing an active rehabilitation footprint on Medicaid. These therapy volumes suggest the facility maintains an organized PT/rehab service line that contributes meaningfully to ancillary revenue.

There are notable ancillary and specialized services in the Medicaid mix that point to onsite capabilities beyond typical ED care. A dental-related code 41899 produced $833.3K (3.4%) and a proprietary respiratory panel 0202U generated $287.4K (1.2%), implying availability of either dental/oral procedures and advanced molecular respiratory testing within the hospital or its outpatient services.

The provider’s NPI was enumerated on 2006-07-03 (~20 years ago), indicating an established presence in the market; the longevity helps contextualize persistent ED- and observation-oriented billing patterns rather than a short-term surge in activity. This tenure supports interpreting the observed code mix as stable operational specialization rather than a transient change.

Medicaid: Complete Services Breakdown

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

242 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.	42,730	$200	$8.5M
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.	19,790	$200	$3.9M
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.	19,680	$140	$2.8M
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.	6,480	$250	$1.6M
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.	4,680	$200	$913K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	950	$880	$833.3K
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.	4,290	$170	$730K
G0378	Hospital observation service, per hour	5,740	$110	$602.8K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	4,950	$100	$505.2K
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…	10,480	$40	$450.8K

Showing 1–10 of 242

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Wellmont Health System — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

242 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	27	60	1,340	$50	$1.1M
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.	28	630	510	$120	$1.1M
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.	58	610	570	$110	$884.4K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	10	30	410	$520	$719.2K
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.	32	570	640	$100	$637.8K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	178	230	2,130	$40	$616.8K
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	5	20	1,060	$210	$535.6K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	21	100	400	$60	$524.7K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	88	340	1,400	$40	$354.2K
G0378	Hospital observation service, per hour	5	100	410	$210	$264K

Showing 1–10 of 242

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bristol Pediatric Dentistry PLLC	TN	Pediatric Dentistry	$0	$23.4M
Ipc Pac Healthcare Services Of Tennessee PC	TN	Internal Medicine Physician	$0	$8.5M
Blue Ridge Radiology, P.C.	TN	Diagnostic Radiology Physician	$0	$4.2M
Youthcare Pediatrics	TN	Pediatrics Physician	$0	$3.1M
Applachian Recovery Care, PLLC	TN	Addiction Medicine (Internal Medicine) Physician	$0	$2.4M
Ambulance Service Of Bristol Inc	TN	Ambulance	$836.3K	$1.5M
Mountain Empire Cataract & Eye Surgery Center	TN	Ambulatory Surgical Clinic/Center	$953.1K	$929.5K
The Endoscopy Center Of Bristol	TN	Ambulatory Surgical Clinic/Center	$508.4K	$181.3K
Renaissance Surgery Center, LLC	TN	Ambulatory Surgical Clinic/Center	$669.7K	$0
Rick Whiles	TN	Internal Medicine Physician	$634.1K	$0

Wellmont Health System — Billing Profile & Reimbursement Data

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Wellmont Health System — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wellmont Health System	VA	General Acute Care Hospital	$0	$33.7M
Wellmont Health System	TN	General Acute Care Hospital	$0	$17.6M
Elizabeth Jackson	TN	Surgery Physician	$23.5K	$0