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.

Upmc Children's Hospital Of Pittsburgh (NPI 1164426896)

Field	Value
Entity Type	Organization
Organization	Upmc Children's Hospital Of Pittsburgh
Address	4401 Penn Ave
City	Pittsburgh
State	PA
ZIP	15224
Taxonomy	Children's Hospital
NPI Enumerated	June 10, 2005

Payer Source	Total Paid
Medicaid	$83M
Medicare	$0

Key Findings

UPMC CHILDREN'S HOSPITAL OF PITTSBURGH reports $83M in lifetime Medicaid revenue and has no Medicare billing on file, making its claims footprint effectively single‑payer in the available dataset. The absence of Medicare activity means analyses of this provider should prioritize Medicaid contracting, utilization, and network impact rather than Medicare comparatives.

Revenue is highly concentrated: the top three Medicaid codes (99284, 99283, G0378) account for 48.8% of this provider's total Medicaid revenue. Those codes individually generate $11.9M (99284), $11.9M (99283), and $7.5M (G0378), indicating a heavy dependence on a small set of high-volume services.

The code mix and volumes point to a dominant emergency medicine and observation operation: 99283 shows 68.8K claims and $11.9M revenue (18.5% of Medicaid revenue) and is described as an extreme outlier in-state (rank #6 of 1063, 100th percentile). 99284 records 40.5K claims and $11.9M revenue (18.6%) and is notably above typical state volume (rank #30 of 1604, 98th percentile), while G0378 (hospital observation service) lists 10.2K claims and $7.5M revenue (11.7%) and is also notably above typical state volume (rank #4 of 149, 98th percentile).

Pediatric procedural services are another clear service line: 69436 (tympanostomy) generates $2.3M (3.5% of Medicaid revenue) on 3.2K claims and is an extreme outlier in-state (rank #1 of 50, 100th percentile), and 42820 (tonsil/adenoid removal) contributes $404.5K. These volumes are consistent with high surgical throughput for common pediatric ENT procedures.

Infusion and specialty drug therapy represent meaningful revenue streams: J1745 (infliximab) produced $5.8M (9.0% of Medicaid revenue) on 2.6K claims and ranks #3 of 18 in-state (88th percentile), while J1569 (immune globulin) and J3380 (vedolizumab) contribute $2.4M and $422K respectively. Chemotherapy administration (96413) also appears with $1M revenue, indicating on-site infusion/complex therapy capacity beyond acute emergency care.

Diagnostic imaging, cardiac imaging, and ancillary pediatric services are well-represented: 70551 (MRI brain, no contrast) accounts for $1.3M (rank #6 of 139, 96th percentile), 93303/93306 (echocardiography codes) together contribute over $1.4M, and sleep study 95782 and audiology codes V5261 and 92507 add substantial ancillary volume. This mix suggests an integrated diagnostic and subspecialty platform supporting both inpatient/ED care and outpatient specialty visits.

Several codes show institution-level dominance in-state beyond ED services: J1100 (dexamethasone injection) appears as an extreme outlier with 20.9K claims and $376.9K revenue (rank #1 of 306, 100th percentile), and multiple imaging and procedure codes reside at high percentiles (for example, 70551 at 96th and 93303 at 95th). Taken together, these ranks and labels indicate the provider is a major Medicaid-volume center in Pennsylvania for multiple pediatric acute, procedural, and ancillary services.

The provider has long tenure in the NPI file (enumerated 2005-06-10, ~21 years ago), which, combined with concentrated Medicaid revenue of $83M and heavy dependence on a few high-volume codes, has implications for payers: Medicaid plans contracting with or managing utilization for this facility will want to focus on emergency department flows, observation stays, high-volume pediatric surgical procedures, and on-site infusion services as primary drivers of spend and capacity risk.

Medicaid: Complete Services Breakdown

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

527 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.	40,480	$300	$11.9M
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.	68,770	$170	$11.9M
G0378	Hospital observation service, per hour	10,240	$740	$7.5M
D2930	N/A	5,950	$1,140	$6.8M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	2,590	$2,240	$5.8M
T1015	Clinic visit/encounter, all-inclusive	32,360	$80	$2.6M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	1,120	$2,150	$2.4M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	3,180	$720	$2.3M
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.	9,240	$210	$2M
70551	The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam.	2,930	$460	$1.3M

Showing 1–10 of 527

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

Upmc Children's Hospital Of Pittsburgh — 10 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

527 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	3	10	1,120	$1,340	$2.5M
G0481	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…	23	20	710	$80	$1.7M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	6	10	770	$1,290	$1.6M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	3	20	350	$1,720	$1.6M
G0378	Hospital observation service, per hour	4	150	510	$870	$1.4M
T1015	Clinic visit/encounter, all-inclusive	92	1,690	760	$170	$1.2M
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…	47	130	310	$60	$769.3K
J3380	Injection, vedolizumab, intravenous, 1 mg	4	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.	63	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…	22	200	990	$70	$517.5K

Showing 1–10 of 527

Nearby Providers

Other providers in the same ZIP code as Upmc Children's Hospital Of Pittsburgh, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Penn Allegheny Health System Inc	PA	General Acute Care Hospital	$0	$12.7M
Daljit Singh	PA	Internal Medicine Physician	$381.3K	$85.3K
Ravi Kondaveeti	PA	Gastroenterology Physician	$105.6K	$307.5K
Bryce Braaksma	PA	Orthopaedic Surgery Physician	$250.8K	$0
Craig Conti	PA	Foot & Ankle Surgery Podiatrist	$172.3K	$0
David Hakas	PA	Nephrology Physician	$137.3K	$1K
Nisarg Mehta	PA	Surgery Physician	$134.8K	$0
Sanjeev Katyal	PA	Diagnostic Radiology Physician	$134.7K	$0
Dolores Dominguez Santamaria	PA	Neurology Physician	$73K	$2.8K
Jeffrey Varga	PA	Anesthesiology Physician	$19.4K	$50K

Upmc Children's Hospital Of Pittsburgh — Billing Profile & Reimbursement Data

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Upmc Children's Hospital Of Pittsburgh — 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