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

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

Connecticut Children's Medical Center (NPI 1134271661)

Field	Value
Entity Type	Organization
Organization	Connecticut Children's Medical Center
Address	282 Washington St
City	Hartford
State	CT
ZIP	06106
Taxonomy	Children's Hospital
NPI Enumerated	January 17, 2007

Payer Source	Total Paid
Medicaid	$248.8M
Medicare	$0

Key Findings

CONNECTICUT CHILDREN'S MEDICAL CENTER reports $248.8M in lifetime Medicaid revenue and has no Medicare billing on file, making its reported activity effectively single‑payer (Medicaid) in scale. This concentrated payer mix means Medicaid reimbursement patterns will largely determine the provider's top-line billing profile and utilization signals.

Revenue is highly concentrated in emergency department evaluation and management codes: 99285 ($42.8M, 21.8%), 99283 ($23.7M, 12.1%) and 99284 ($22.1M, 11.3%) together account for 45.2% of the provider's total Medicaid revenue. That 45.2% precomputed share indicates the ED is the primary revenue driver for this provider.

The code mix and descriptions identify the facility as a high‑volume pediatric acute care and surgical center: substantial Medicaid revenue appears in ENT surgical procedures such as 42820 ($14.5M) and 42830 ($4M), and in observation/hospital admission codes like G0379 ($4.5M). These procedural and observation codes, paired with the ED revenue concentration, are consistent with a children’s hospital that manages both emergency intake and operative pediatric cases.

High volumes of rehabilitation and developmental services are apparent across Medicaid: 97110 (92.9K claims, $6.9M; 97th percentile), 97530 (84.1K claims, $4.2M; 100th percentile, labeled an extreme outlier), and speech therapy 92507 (46.7K claims, $4.3M; 98th percentile, labeled an extreme outlier). These counts and percentile standings indicate a robust ambulatory therapy footprint supporting ongoing outpatient and post‑acute pediatric care.

The provider is a meaningful state player in specialty infusions and biologic therapies: J1745 (infliximab, $15.1M) ranks #2 of 11 providers in-state (90th percentile, notably above typical state volume) and J3380 (vedolizumab, $6.9M) ranks #1 of 8 providers in-state (100th percentile). Chemotherapy administration (96413, $3M) also appears in the top 25, signaling an oncology/infusion capability beyond routine pediatric care.

Diagnostic sleep and cardiology services are prominent revenue contributors: polysomnography 95810 ($5.4M) ranks #2 of 52 in-state (98th percentile, notably above typical) and attended pediatric sleep study 95782 ($2.8M) ranks #1 of 4 (100th percentile). Transthoracic echo codes (93303, 93306, 93304) also appear among top codes, showing sizeable investments in pediatric cardiac diagnostics.

Several individual codes show market leadership in Connecticut: 99282 is ranked #1 of 58 providers (100th percentile; labeled an extreme outlier, far above typical state volume) and the provider also ranks #1 for codes such as J3380, 42830, 69436 and 93304. At the same time, core ED codes 99283 and 99284 sit at the 95th and 83rd percentiles respectively, indicating both exceptional volume in some ED acuity bands and typical volumes in others. This mix portrays the hospital as a dominant in‑state pediatric provider for a subset of services while remaining a strong but not exclusive participant on others.

The provider's NPI was enumerated on 2007-01-17 (~19 years ago), reflecting long tenure in the market. Given the absence of Medicare billing and the heavy Medicaid concentration, stakeholders should treat state Medicaid reimbursement changes or policy shifts as potentially material to the hospital’s revenue profile and service economics.

Medicaid: Complete Services Breakdown

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

466 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	21,910	$1,950	$42.8M
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.	100,630	$240	$23.7M
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.	52,550	$420	$22.1M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	7,570	$2,000	$15.1M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	2,840	$5,090	$14.5M
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.	83,770	$140	$11.4M
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…	92,920	$70	$6.9M
J3380	Injection, vedolizumab, intravenous, 1 mg	1,590	$4,330	$6.9M
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,…	5,600	$970	$5.4M
G0379	Direct admission of patient for hospital observation care	2,070	$2,160	$4.5M

Showing 1–10 of 466

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Connecticut Children's Medical Center — 12 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

466 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	21	40	21,520	$90	$8M
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.	33	130	520	$330	$5.9M
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.	23	130	690	$180	$4.7M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	2	10	760	$3,080	$4.4M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	23	40	23,540	$140	$3.7M
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.	7	110	1,520	$140	$3.4M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	2	10	330	$1,810	$3.3M
44970	Laparoscopy, surgical, appendectomy	2	10	230	$4,770	$1.7M
J3380	Injection, vedolizumab, intravenous, 1 mg	1	10	220	$3,930	$1.6M
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	1	10	1,810	$690	$1.2M

Showing 1–10 of 466

Nearby Providers

Other providers in the same ZIP code as Connecticut Children's Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hartford Dispensary	CT	Substance Use Disorder Rehabilitation Clinic/Center	$1.6M	$122.8M
Connecticut Children's Specialty Group, Inc.	CT	Pediatrics Physician	$0	$59.8M
Hartford Healthcare Medical Group Specialists, PLLC	CT	Surgery Physician	$0	$46M
Charter Oak Health Center, Inc.	CT	Federally Qualified Health Center (FQHC)	$0	$42.5M
Hartford Dispensary	CT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$26.1M
Aetna Ambulance Service, Inc	CT	Land Ambulance	$2.9M	$22.2M
Home Care Vna, LLC	CT	Home Health Agency	$0	$12.4M
Connecticut Gi PLLC	CT	Gastroenterology Physician	$0	$12M
Charter Oak Health Center, Inc.	CT	Federally Qualified Health Center (FQHC)	$0	$8M
Dierks Dialysis LLC	CT	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4.2M

Connecticut Children's Medical Center — Billing Profile & Reimbursement Data

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Connecticut Children's Medical Center — 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

Nearby Providers

Frequently Asked Questions

References