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

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

Lehigh Valley Hospital (NPI 1164400131)

Field	Value
Entity Type	Organization
Organization	Lehigh Valley Hospital
Address	1200 S Cedar Crest Blvd
City	Allentown
State	PA
ZIP	18103
Taxonomy	General Acute Care Hospital
NPI Enumerated	January 9, 2006

Payer Source	Total Paid
Medicaid	$64.3M
Medicare	$0

Key Findings

LEHIGH VALLEY HOSPITAL reports no Medicare billing on file and is effectively a single‑payer (Medicaid) operation in the available dataset, with Total Medicaid revenue of $64.3M. The absence of Medicare revenue means comparisons to national Medicare peers are not possible and analysis should focus on Medicaid activity and state-level competitive positioning.

Revenue is highly concentrated in a small set of Medicaid service lines: the precomputed top three Medicaid codes (99284, 99283, T1015) account for 69.4% of the provider's Medicaid revenue. Those top three items are 99284 at $19.3M (35.3% of total Medicaid revenue), 99283 at $11.9M (21.7%), and T1015 at $6.8M (12.4%), indicating that a few high-volume E/M and clinic encounter codes drive the bulk of payout.

The code mix strongly indicates a high-volume emergency department and acute care footprint: 99284 (ED, moderate MDM) is $19.3M with 88.4K claims and ranks #8 of 1604 providers in-state (100th percentile; extreme outlier), while 99283 (ED, low MDM) is $11.9M with 63.8K claims and ranks #7 of 1063 providers in-state (99th percentile; extreme outlier). In addition, 99285 (ED, high MDM) contributes $4.7M (8.5% of Medicaid revenue) and ranks #26 of 1228 providers in-state (98th percentile), reinforcing that ED services are a dominant operational focus.

Clinical and observation services complement the ED concentration: G0378 (hospital observation service, per hour) is $4.7M (8.6% of Medicaid revenue) and ranks #17 of 149 providers in-state (89th percentile; typical), while T1015 (clinic visit/encounter, all-inclusive) is $6.8M and ranks #10 of 1691 providers in-state (99th percentile; extreme outlier). These patterns are consistent with high throughput of observation and outpatient clinic encounters tied to acute care workflows.

The hospital shows specialty and procedural breadth beyond ED and observation care: oncology biologics such as J9271 (pembrolizumab) appear at $734.8K and rank #10 of 24 providers in-state (61th percentile; typical), and infusion agents J1745 and J3380 are present though at modest state ranks. Advanced imaging and diagnostics also contribute meaningfully with codes like 74177 ($562.7K; ranks #24 of 484, 95th percentile), 70553 ($378.2K; ranks #17 of 147, 89th percentile), and 78815 ($263.7K; ranks #12 of 53, 79th percentile).

High laboratory, EKG, and basic diagnostic volumes are evident and reflect large patient throughput: 80053 (CMP) shows 67K claims for $469.3K and ranks #8 of 339 providers in-state (98th percentile; notably above typical), 93005 (ECG technical component) has 31.8K claims for $222.9K and ranks #4 of 220 providers in-state (99th percentile; extreme outlier), and U0003/87637 (SARS‑CoV‑2/respiratory testing) appear with notable but smaller Medicaid revenue ($768.7K and $226.8K respectively).

Rehabilitation and outpatient therapy activity is also concentrated relative to peers: 97161 (PT evaluation, low complexity) is $236.5K and ranks #2 of 136 providers in-state (99th percentile; extreme outlier), and therapy codes 97110 and 97161 together indicate a meaningful PT service line that is large relative to most in‑state hospitals. These high percentiles suggest the provider is a major local hub for both acute and rehabilitative outpatient care.

LEHIGH VALLEY HOSPITAL has been enumerated since 2006‑01‑09 (~20 years ago), signaling an established presence in the market. Given its longevity plus the Medicaid volume and extreme percentile rankings on multiple ED, diagnostic, and outpatient codes, the hospital functions as a dominant statewide provider for emergency and high‑throughput outpatient services within the Medicaid population, but offers no Medicare comparators in this dataset to assess cross‑payer footprint.

Medicaid: Complete Services Breakdown

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

538 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.	88,360	$220	$19.3M
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.	63,780	$190	$11.9M
T1015	Clinic visit/encounter, all-inclusive	137,820	$50	$6.8M
G0378	Hospital observation service, per hour	4,100	$1,150	$4.7M
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.	24,610	$190	$4.7M
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…	13,250	$60	$768.7K
J9271	Injection, pembrolizumab, 1 mg	590	$1,250	$734.8K
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.	4,360	$130	$562.7K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	10,080	$50	$483.8K
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.	67,040	$10	$469.3K

Showing 1–10 of 538

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Lehigh Valley Hospital — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

538 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	8	20	350	$1,720	$1.6M
G0378	Hospital observation service, per hour	17	150	510	$870	$1.4M
J2323	Injection, natalizumab, 1 mg	5	10	240	$2,130	$1.2M
T1015	Clinic visit/encounter, all-inclusive	10	1,690	760	$170	$1.2M
J9271	Injection, pembrolizumab, 1 mg	10	20	420	$1,230	$827.7K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	27	130	310	$60	$769.3K
J3380	Injection, vedolizumab, intravenous, 1 mg	7	10	140	$2,680	$758.7K
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.	109	210	730	$40	$689.7K
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	200	990	$70	$517.5K
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…	219	410	1,130	$60	$455.4K

Showing 1–10 of 538

Related Providers

Other providers that share a Tax Identification Number (TIN) with Lehigh Valley Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lehigh Valley Physician Group	PA	Family Medicine Physician	$0	$21.9M
Lehigh Valley Physician Group	PA	Emergency Medicine Physician	$0	$16.3M
Lehigh Valley Hospital Pocono	PA	General Acute Care Hospital	$0	$11.9M
Family Care Centers Inc.	PA	Internal Medicine Physician	$0	$11.1M
Lehigh Valley Hospital	PA	Children's Hospital	$0	$10M
Hazleton Professional Services	PA	Internal Medicine Physician	$0	$8.3M
Lehigh Valley Physician Group	PA	Pediatrics Physician	$0	$7.6M
Family Care Centers Inc	PA	Family Medicine Physician	$0	$6.1M
Lehigh Valley Physician Group	PA	Pediatric Emergency Medicine (Emergency Medicine) Physician	$0	$5.9M
Eugene Grady	PA	Rheumatology Physician	$1.7M	$980

Nearby Providers

Other providers in the same ZIP code as Lehigh Valley Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Preferred Home Health Care & Nursing Services Inc.	PA	Home Health Agency	$0	$12.1M
Efcc Acquisition Corp	PA	Home Health Agency	$0	$9.6M
Medical Imaging Of Lehigh Valley PC	PA	Diagnostic Radiology Physician	$0	$9.5M
Masayuki Kazahaya	PA	Ophthalmology Physician	$3.7M	$0
Ya-yu Lee	PA	Endocrinology, Diabetes & Metabolism Physician	$831K	$0
Neil Feldman	PA	Allergy Physician	$808K	$1.6K
Susan Kim	PA	Rheumatology Physician	$770.1K	$0
Steven Oberlender	PA	MOHS-Micrographic Surgery Physician	$760K	$0
David De Rose	PA	Ophthalmology Physician	$715.7K	$0
Eric Lebby	PA	Adult Reconstructive Orthopaedic Surgery Physician	$624.4K	$0

Lehigh Valley Hospital — 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