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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Presbyterian Healthcare Services (NPI 1154307593)

Key Findings

Field	Value
Entity Type	Organization
Organization	Presbyterian Healthcare Services
Address	1010 Spruce St
City	Espanola
State	NM
ZIP	87532
Taxonomy	Rural Acute Care Hospital
NPI Enumerated	December 19, 2005

Payer Source	Total Paid
Medicaid	$40.9M
Medicare	$0

PRESBYTERIAN HEALTHCARE SERVICES shows an effectively single‑payer billing profile: there is no Medicare billing on file and reported lifetime Medicaid revenue of $40.9M, indicating Medicaid is the dominant — in this case sole — recorded public payer for this facility. The provider’s NPI was enumerated on 2005-12-19 (~21 years ago), reflecting long-standing enrollment and an established presence in its community.

Revenue is highly concentrated in emergency department evaluation-and-management codes: the top three Medicaid codes (99284, 99283, 99285) together account for 60.7% of the provider’s total Medicaid revenue. Individually those codes generate $7.8M (22.7%) for 99284, $7.3M (21.3%) for 99283, and $5.8M (16.7%) for 99285, which signals that ED visits are the primary revenue driver for this hospital under Medicaid.

The code mix and descriptions point to an ED-centric, acute care operation with substantial downstream support services: high-revenue ED E/M codes are complemented by significant ambulance transport claims (A0429 $1.4M, 4.0%; A0427 $1.1M, 3.1%) and advanced imaging (74177 $1.3M, 3.8%; 70450 $777.1K, 2.3%). This combination is consistent with a rural acute care hospital that triages and treats a steady stream of emergent patients and relies on ancillary transport and imaging to support those cases.

Competitively, the provider registers above-average in-state positioning for its ED volumes but is described in the data as reporting “typical, unremarkable volume” for those codes: 99283 ranks #7 of 84 providers in-state (93rd percentile), 99284 ranks #11 of 76 (87th percentile), and 99285 ranks #13 of 71 (83rd percentile). In plain terms, PRESBYTERIAN competes as a meaningful ED participant in New Mexico — frequently busier than many peers — but the data labels these volumes as within the expected range rather than outlier dominance.

Laboratory and respiratory testing comprise a visible ancillary revenue stream consistent with emergency and inpatient workups: 87636 (SARS–CoV–2/flu multiplex) brings $1.6M (4.8%) and ranks #4 of 26 in-state (88th percentile), while multiplex respiratory testing 87631 contributes $623.6K (1.8%) and ranks #5 of 29 (86th percentile). Routine panels and hematology also appear at scale (80053 $413.4K, 1.2%; 85025 $263.5K, 0.8%), underscoring an on-site lab footprint that supports high ED throughput.

Outpatient clinic, observation, therapy, and infusion codes signal diversified outpatient activity beyond the ED: G0463 (hospital outpatient clinic visits) accounts for $593.7K (1.7%), 97110 (therapeutic exercise) $591.1K (1.7%), and infusion/IV administration codes 96375, 96365, 96374 collectively add several hundred thousand in revenue. These lines suggest the hospital operates outpatient management, rehabilitation, and infusion services that supplement emergency demand and provide additional Medicaid revenue streams.

The Medicaid revenue profile shows operational dependence on emergency care volumes — with 60.7% of Medicaid dollars coming from three ED codes — which creates exposure to changes in ED visit patterns or Medicaid reimbursement policy for those services. Coupled with notable but smaller contributions from transport, imaging, lab, and outpatient clinic codes, the facility appears to have built a classic rural acute-care mix where ED throughput anchors overall revenue stability.

Specific mid-tier procedure volumes further characterize the facility’s scope of services: high-use diagnostics and monitoring include 93005 (ECG without interpretation) with 11.3K claims generating $623.5K (1.8%) and chest X-ray 71046 with $375.4K (1.1%), while knee radiography 73562 is relatively strong at $340.8K (1.0%) and ranks #6 of 71 providers in-state (93rd percentile). These patterns support the picture of a facility performing frequent emergency-focused diagnostics and monitoring for an active patient population under Medicaid.

Medicaid: Complete Services Breakdown

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

254 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.	47,930	$160	$7.8M
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.	54,810	$130	$7.3M
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.	25,530	$230	$5.8M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	12,220	$140	$1.6M
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	5,240	$260	$1.4M
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.	3,770	$350	$1.3M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	4,420	$240	$1.1M
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.	4,570	$170	$777.1K
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.	6,900	$100	$662.4K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	4,420	$140	$623.6K

Showing 1–10 of 254

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Presbyterian Healthcare Services — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

254 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	11	80	12,050	$160	$3.9M
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.	13	70	6,920	$210	$3.5M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	12	40	3,670	$80	$3.2M
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	80	10,650	$130	$2.4M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	13	50	1,320	$270	$2M
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.	20	60	3,070	$210	$1.4M
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	12	60	1,850	$260	$1.2M
G0378	Hospital observation service, per hour	22	40	1,000	$400	$1M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	4	30	3,760	$120	$900.7K
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.	20	60	2,820	$110	$799.5K

Showing 1–10 of 254

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Darrins Place Inc	NM	Community/Behavioral Health Agency	$0	$26M
El Centro Family Health	NM	Federally Qualified Health Center (FQHC)	$0	$11.6M
Ideal Home Care, Inc.	NM	In Home Supportive Care Agency	$0	$9M
Presbyterian Medical Services	NM	Federally Qualified Health Center (FQHC)	$0	$7.6M
Familia Dental Esp LLC	NM	Dental Clinic/Center	$0	$4.1M
Las Cumbres Community Services	NM	Early Intervention Provider Agency	$0	$3.7M
El Centro Family Health	NM	Federally Qualified Health Center (FQHC)	$0	$3.2M
Las Cumbres Community Services	NM	Community/Behavioral Health Agency	$0	$1.6M
Bio-medical Applications Of New Mexico, Inc.	NM	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.4M
Carey Reed	NM	Psychiatric/Mental Health Clinical Nurse Specialist	$341.4K	$0

Presbyterian Healthcare Services — 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
Presbyterian Healthcare Services	NM	General Acute Care Hospital	$0	$345.3M
Presbyterian Healthcare Services	NM	Internal Medicine Physician	$0	$240.8M
Centra Medical Group, LLC	VA	Family Medicine Physician	$0	$60.1M
Presbyterian Healthcare Services	NM	Rural Acute Care Hospital	$0	$47.6M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$33.1M
Presbyterian Healthcare Services	NM	General Acute Care Hospital	$0	$21.6M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$20.6M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$8.5M
Christopher Roybal	NM	Ophthalmology Physician	$3.8M	$0
Presbyterian Healthcare Services	NM	Home Health Agency	$0	$3.3M