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

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

Tmc/higgins General Hospital (NPI 1194712083)

Key Findings

Field	Value
Entity Type	Organization
Organization	Tmc/higgins General Hospital
Address	200 Allen Memorial Dr
City	Bremen
State	GA
ZIP	30110
Taxonomy	Critical Access Hospital
NPI Enumerated	October 5, 2005

Payer Source	Total Paid
Medicaid	$12.2M
Medicare	$0

This provider is effectively single‑payer on file: there is no Medicare billing on file and reported lifetime Medicaid revenue is $12.2M, so all recorded federal fee‑for‑service activity is concentrated in Medicaid. That concentration means Medicare-specific bench‑marks and national peer comparisons cannot be used to assess its performance because no Medicare claims are present for analysis.

Revenue concentration is high: the precomputed top three Medicaid codes (99283, 99284, 74177) account for 56.9% of this provider’s total Medicaid revenue. Those top codes are reported as $2.9M (25.1%) for 99283, $2.4M (20.6%) for 99284, and $1.3M (11.2%) for 74177, together representing the majority of the $12.2M Medicaid intake.

The code mix shows an emergency‑department centric operation: multiple ED E/M codes appear among the highest‑revenue items (99283, 99284, 99285, 99282, 99281), with the two largest single codes being 99283 ($2.9M) and 99284 ($2.4M). This pattern indicates that the hospital’s Medicaid revenue is driven by ED visits across low, moderate, and higher complexity levels rather than by elective inpatient procedures.

Imaging and diagnostic services are a significant ancillary revenue stream: 74177 (CT abdomen/pelvis with contrast) is the third largest code at $1.3M (11.2%), and CT head 70450 generates $496.5K (4.3%). The presence of high‑revenue CT codes alongside frequent chest radiographs (71045, $202.1K) supports on‑site advanced imaging capacity that complements ED throughput.

Laboratory and short‑course therapeutic services are material and operationally notable: 87428 (SARS/flu multiplex immunoassay) produced $290.7K (2.5%) and is marked in the dataset as notably above typical state volume, while drug/IV administration codes (96375, 96365, 96361, 96374) and point‑of‑care testing (80307) together indicate regular infusion and lab workflows tied to acute care. The explicit label for 87428 is "notably above typical state volume," signaling unusually high testing intensity for respiratory pathogens relative to state peers.

Competitive standing within the state is mixed but generally modest-to-strong on key ED codes: 99283 ranks #21 of 237 providers in-state (92th percentile) and 99284 ranks #26 of 231 (89th percentile) yet both are described in the dataset as "typical, unremarkable volume;" 74177 ranks #22 of 70 (70th percentile) also labeled "typical, unremarkable volume." Meanwhile 87428’s position (#6 of 60, 92th percentile) is explicitly called out as above typical, identifying a clear area of relative strength versus in‑state peers.

Operational and financial implications follow from tenure and concentration: TMC/HIGGINS GENERAL HOSPITAL is a Critical Access Hospital with an NPI enumerated on 2005-10-05 (~21 years ago), positioning it as an established rural acute care facility. The combination of long tenure, ED‑driven Medicaid revenue, and the fact that the top three codes account for 56.9% of Medicaid revenue suggests the hospital’s near‑term revenue sensitivity to changes in ED volume or Medicaid policy, and it may have limited Medicare leverage given no Medicare billing on file.

Medicaid: Complete Services Breakdown

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

123 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	19,880	$150	$2.9M
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.	10,860	$220	$2.4M
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.	2,120	$610	$1.3M
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.	2,670	$240	$635.2K
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.	2,140	$230	$496.5K
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…	12,850	$40	$488.3K
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.	4,960	$80	$411.7K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	690	$540	$368.6K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	6,460	$50	$290.7K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	4,950	$50	$232.7K

Showing 1–10 of 123

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Georgia Distribution

Tmc/higgins General Hospital — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

123 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.	34	140	200	$280	$1.9M
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.	26	230	120	$170	$937.5K
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.	21	240	170	$120	$779.3K
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	12	30	3,810	$70	$500.3K
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.	36	70	2,840	$30	$428.7K
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.	22	70	380	$170	$423K
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.	17	50	600	$90	$409.7K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	60	80	1,770	$60	$366K
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…	8	60	730	$60	$362.1K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	13	30	2,120	$70	$325.4K

Showing 1–10 of 123

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Independence Emergency Physicians LLC	GA	Emergency Medicine Physician	$0	$1.1M
Tmc Haralson Family Healthcare Center	GA	Rural Health Clinic/Center	$0	$979.4K
Ambucare, LLC	GA	Land Ambulance	$597.7K	$0
Allison Key	GA	Family Medicine Physician	$427.5K	$0
Robert Patrick	GA	Certified Registered Nurse Anesthetist	$4.7K	$0

Tmc/higgins General Hospital — Billing Profile & Reimbursement Data

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Tmc/higgins General 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

Nearby Providers

Frequently Asked Questions

References