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.

Charleston Area Medical Center, Inc. (NPI 1124248752)

Key Findings

Field	Value
Entity Type	Organization
Organization	Charleston Area Medical Center, Inc.
Address	501 Morris St
City	Charleston
State	WV
ZIP	25301
Taxonomy	General Acute Care Hospital
NPI Enumerated	April 26, 2007

Payer Source	Total Paid
Medicaid	$50.9M
Medicare	$0

CHARLESTON AREA MEDICAL CENTER, INC. is effectively a Medicaid-focused hospital: it has no Medicare billing on file and reports Total Medicaid revenue of $50.9M. Its taxonomy is General Acute Care Hospital and its NPI was enumerated on 2007-04-26 (~19 years ago), indicating nearly two decades of billing history under the current registration.

Revenue is highly concentrated in a small set of evaluation-and-management codes: the top three Medicaid codes 99213, 99232, and 99214 together account for 35.2% of the provider's total Medicaid revenue. Individually these codes each generate multi-million-dollar revenue lines ($5.3M for 99213, $5.2M for 99232, $4.9M for 99214), signaling that ambulatory and inpatient E/M encounters are the primary drivers of Medicaid reimbursement.

The code mix points to a broad acute-care operation with high-volume outpatient, emergency, and inpatient services. Large claim volumes for office/outpatient E/M (99213: 125.6K claims; 99214: 90.3K claims), inpatient follow-up and initial visits (99232: 112.1K claims; 99222/99223 present at high revenue), and substantial ED coding (99283: 89.7K claims; 99284: 55.5K claims) together indicate the facility handles a heavy throughput across ambulatory clinics, the emergency department, and inpatient wards.

Charleston Area Medical Center is a dominant statewide provider for many high-revenue Medicaid codes: several codes are ranked at the very top in-state, including 99223 at #1 of 114 providers (100th percentile, extreme outlier), 99239 at #1 of 57 providers (100th percentile, extreme outlier), and multiple additional codes in the 98–100th percentiles. These rank/percentile patterns describe a provider that is a major hub for acute E/M and inpatient services in West Virginia.

Several procedural and diagnostic services further diversify Medicaid revenue beyond pure E/M care: high-volume diagnostic codes such as 93306 (27.6K claims, $1.1M revenue, ranks #2 of 103 providers, 99th percentile) and 93010 (151.7K claims, $758.5K revenue, ranks #2 of 152 providers, 99th percentile) and pathology codes 88305 and 88307 show significant ancillary imaging and lab/pathology activity supporting a full-service hospital platform. A surgical procedure with high per-claim payment, 43282 ($421.3K revenue, ranks #1 of 2 providers), indicates occasional higher-acuity surgical cases billed to Medicaid.

The provider shows extreme high-volume specialization on many codes versus in-state peers: multiple codes are labeled as "extreme outlier" (e.g., 99213, 99232, 99214, 99233) and others as "notably above typical state volume" (e.g., 99284, 99291). These qualitative outlier labels, together with frequent top-2/statewide rankings, reinforce that Charleston Area Medical Center is well above typical state volumes across a range of acute-care services rather than exhibiting isolated spikes.

Operational implications for payers and network planners: given that a large share of Medicaid revenue is concentrated in standard E/M and emergency/inpatient codes, utilization-management or network-design efforts focused on ED throughput, inpatient care pathways, and outpatient follow-up could materially affect reimbursement and patient flow. The combination of very high claim counts (e.g., 125.6K claims for 99213; 112.1K claims for 99232) and top statewide rankings suggests this facility is a central referral and treatment site for Medicaid beneficiaries.

Although the provider posts some codes with typical, unremarkable statewide volume (for example 99285 ranks #25 of 132 providers, 82th percentile and is described as typical), the overall pattern is one of concentration and dominance in Medicaid acute-care E/M services. For analysts evaluating competitive standing or contracting, Charleston Area Medical Center should be treated as a major Medicaid provider with extensive service capacity across ED, inpatient, outpatient, diagnostic, and pathology lines.

Medicaid: Complete Services Breakdown

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

290 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…	125,610	$40	$5.3M
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…	112,060	$50	$5.2M
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…	90,310	$50	$4.9M
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.	55,510	$80	$4.4M
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.	89,740	$50	$4.2M
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…	32,910	$70	$2.2M
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…	25,470	$80	$2M
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…	18,710	$100	$1.9M
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.	56,620	$30	$1.8M
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…	12,230	$130	$1.6M

Showing 1–10 of 290

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

Charleston Area Medical Center, Inc. — 22 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

290 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	25	130	2,090	$210	$1.5M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	29	40	820	$30	$1.2M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	30	40	820	$30	$1.2M
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.	5	170	3,350	$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.	2	160	3,690	$80	$714.8K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	104	110	2,080	$50	$537.1K
43282	The provider performs repair of a paraesophageal hernia, where the stomach slides up next to the esophagus, using laparoscopy. He may also perform fundoplasty, wrapping part of the stomach around the…	1	10	490	$930	$456.6K
01922	The provider performs anesthesia services for a patient undergoing non–invasive imaging or radiation therapy.	3	10	1,740	$130	$346.6K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	85	110	5,530	$20	$344.8K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	9	20	150	$700	$308.2K

Showing 1–10 of 290

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Charleston Area Medical Center Inc	WV	General Acute Care Hospital	$0	$200.1M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Rainelle Medical Center Inc	WV	Federally Qualified Health Center (FQHC)	$0	$14.3M
Mark Le	FL	Diagnostic Radiology Physician	$10.7M	$0
Rajiv Khanna	WV	Medical Oncology Physician	$2M	$0
Charleston Area Medical Center, Inc.	WV	Hospitalist Physician	$0	$1.4M
Mayez El-harake	WV	Medical Oncology Physician	$1.1M	$0
Linda Armstrong	GA	Diagnostic Radiology Physician	$643.9K	$175.1K
Robert Fried	KY	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	$719.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wv Birth To Three	WV	Early Intervention Provider Agency	$0	$59.9M
Children's Home Society Of West Virginia	WV	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$44.1M
Kanawha County Emergency Ambulance Authority	WV	Land Ambulance	$2.3M	$31.9M
Maxim Healthcare Services, Inc.	WV	Home Health Agency	$0	$19.9M
All-aid Services, Inc.	WV	Home Health Agency	$0	$16.3M
The Arc Of The Three Rivers, Inc.	WV	Case Management Agency	$0	$15.6M
Retina Consultants, PLLC	WV	Retina Specialist (Ophthalmology) Physician	$0	$13.6M
Dolan & Kalaskey Ltd	WV	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$8.3M
Mindoula Health Inc.	WV	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6.7M
Kanawha Valley Center Inc	WV	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6M

Charleston Area Medical Center, Inc. — Billing Profile & Reimbursement Data

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Charleston Area Medical Center, Inc. — 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