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

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

The Children's Hospital Of Alabama (NPI 1124105762)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Children's Hospital Of Alabama
Address	5295 Preserve Parkway
City	Hoover
State	AL
ZIP	35244
Taxonomy	Pediatrics Physician
NPI Enumerated	November 1, 2006

Payer Source	Total Paid
Medicaid	$17.7M
Medicare	$0

THE CHILDREN'S HOSPITAL OF ALABAMA’s Medicaid billing pattern is concentrated in ambulatory pediatric evaluation/management and preventive care: its top three Medicaid codes are 99213 (80.6K claims, $68 avg paid/claim, $5.5M revenue, 32.4% of Medicaid revenue), 99214 (34.1K claims, $97 avg paid/claim, $3.3M revenue, 19.6%), and 99392 (15.6K claims, $77 avg paid/claim, $1.2M revenue, 7.1%). These codes together reflect routine established-patient visits and well-child preventive visits, indicating the provider operates a high-volume pediatric outpatient/primary care service line.

Revenue concentration is high: the top 3 Medicaid codes by revenue account for 59.1% of this provider's total Medicaid revenue. That degree of concentration means a large share of the $17.7M in Medicaid revenue is driven by a small set of E/M and preventive visit codes, which creates sensitivity to changes in outpatient E/M reimbursement or visit mix.

Payer mix is effectively single-payer Medicaid: there is no Medicare billing on file and total Medicaid revenue is $17.7M. Analysts should treat this entity as primarily Medicaid-dependent when modeling revenue risk, network value, or access impact, since Medicare does not contribute to reported revenue.

Competitive standing in-state is dominant for core pediatric visit codes: 99213 ranks #11 of 1988 providers in Alabama (99th percentile; extreme outlier, far above typical state volume for this code) and 99214 ranks #32 of 1990 providers (98th percentile; notably above typical state volume). The high ranks and percentiles for these high-revenue E/M codes indicate the provider is a major pediatric ambulatory volume hub within the state.

Preventive and immunization services are a substantial secondary revenue stream: codes for well visits and vaccines (99392, 99391, 99393, 90460, 90670, 90698, 90461, 90680, 90686) appear throughout the top-billed list with material claim counts and revenues (for example, 90460: 7.9K claims, $73 avg, $577.6K; 90670: 8.9K claims, $55 avg, $488K). Multiple vaccine codes also rank in high state percentiles (e.g., 90677 ranks #2 of 105, 99th percentile; ranks #6 of 363, 99th percentile), underscoring a large-scale preventive/immunization operation likely integrated into routine pediatric visits.

High-volume diagnostic and point-of-care testing supports the ambulatory model: COVID PCR 87635 shows 18.3K claims ($41 avg, $750.3K) and rapid strep 87880 shows 18.5K claims ($12 avg, $222K), both ranking in the 97th percentile or higher in-state. These testing volumes, alongside large E/M counts (e.g., 99213 at 80.6K claims and 99214 at 34.1K claims), signal substantial patient throughput and on-site testing capability that drive ancillary revenue and operational throughput.

The provider has long tenure in the NPI registry, enumerated on 2006-11-01 (~20 years ago), which, combined with the large Medicaid footprint, implies an established regional pediatric presence. Longevity plus the observed high ranks for multiple service lines supports interpreting this profile as a mature, high-volume pediatric ambulatory practice rather than a new or boutique specialty clinic.

From a risk and strategic perspective, the organization’s reliance on outpatient E/M and preventive/vaccine-driven revenue suggests sensitivity to shifts in primary care visit patterns and public health demand (e.g., seasonal respiratory testing and vaccine campaigns). Given the top-3 concentration (59.1% of Medicaid revenue) and heavy reliance on a handful of high-volume codes, payers should evaluate contract terms, access commitments, and capacity assumptions with an emphasis on outpatient pediatric services.

Medicaid: Complete Services Breakdown

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

78 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…	80,560	$70	$5.5M
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…	34,080	$100	$3.3M
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…	15,620	$80	$1.2M
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…	12,240	$80	$930.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	10,310	$80	$793.5K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	18,300	$40	$750.3K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	13,450	$50	$605.2K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	7,910	$70	$577.6K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	8,870	$60	$488K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,520	$90	$389.1K

Showing 1–10 of 78

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Alabama Distribution

The Children's Hospital Of Alabama — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. Alabama median

78 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	32	1,990	680	$60	$201.7K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	158	330	140	$240	$197.4K
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…	11	1,990	560	$40	$185.6K
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…	11	270	1,360	$60	$159.7K
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…	8	300	1,160	$50	$147.8K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	7	110	610	$40	$143.9K
87634	The lab analyst performs a test for respiratory syncytial virus (RSV) antigen detection using amplified nucleic acid probe technique.	21	60	350	$30	$136.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	10	320	640	$50	$98.1K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	31	160	400	$10	$88.3K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	10	300	210	$40	$77.9K

Showing 1–10 of 78

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eh Health Hospice Of Alabama, LLC	AL	Community Based Hospice Care Agency	$0	$7.2M
Pediatric And Adolescent Dentistry, LLC	AL	Pediatric Dentistry	$0	$5.3M
Stratford Enterprises Inc	AL	Community Based Hospice Care Agency	$0	$4.7M
Medplex Pediatric Dentistry, Inc.	AL	Pediatric Dentistry	$0	$3.9M
Elizabeth Perkins	AL	Rheumatology Physician	$2.9M	$0
William Thomas	AL	Pediatric Dentistry	$0	$2.1M
City Of Hoover	AL	Land Ambulance	$529.7K	$202K
Lauren Bannon	AL	Physician Assistant	$561.1K	$0
Diane Counce	AL	Neurology Physician	$501.8K	$0
Lindsay Kelmenson	AL	Rheumatology Physician	$413.9K	$0

The Children's Hospital Of Alabama — Billing Profile & Reimbursement Data

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The Children's Hospital Of Alabama — 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
The Children's Hospital Of Alabama	AL	Children's Hospital	$0	$59M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$22.2M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$18.4M
The Children's Hospital Of Alabama	AL	Pediatric Otolaryngology Physician	$0	$15.8M
The Children's Hospital Of Alabama	AL	Psychologist	$0	$12M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$7.5M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$5.7M
The Children's Hospital Of Alabama	AL	Pediatric Pulmonology Physician	$0	$5.6M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$5.3M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$4.6M