City And County Of Honolulu — Billing Profile & Reimbursement Data

City and County of Honolulu operates under the Land Ambulance taxonomy and its billing mix is overwhelmingly emergency ground-transport focused: the top revenue-driving codes are A0427 (advanced life support, emergency), A0429 (basic life support, emergency), and A0425 (ground mileage), with A0427 generating $2.6M on Medicare and $4M on Medicaid. This pattern signals an operator whose primary service line is high-acuity emergency ambulance transports rather than non-emergency or ancillary ambulance services.

Revenue concentration is extremely high for both payers: the provider's top 3 Medicare codes account for 97.9% of Medicare revenue and the top 3 Medicaid codes account for 99.0% of Medicaid revenue. Such tight concentration around a handful of emergency transport codes implies material revenue exposure to reimbursement or utilization shifts for those specific codes.

Medicaid is the larger payer relationship in absolute scale: total Medicaid revenue is $5.3M compared with $3.3M of Medicare revenue, so Medicaid represents the dominant source of billings on a lifetime-revenue basis. The facility also reports substantially more Medicaid A0427 claim volume (23.7K claims) than Medicare A0427 claims (5.8K), reinforcing that its ALS emergency activity is driven primarily by Medicaid-covered transports.

On Medicare, the provider is a national outlier for A0427: it ranks #107 of 6841 providers nationally (98th percentile) and is labeled an "extreme outlier, far above typical national volume for this code." Other Medicare codes also sit well above typical national volume but are not extreme outliers (A0429 rank #479/7808 at the 94th percentile; A0425 rank #639/8934 at the 93th percentile; A0433 rank #132/1632 at the 92th percentile), indicating unusually high national activity concentrated around ALS and mileage services.

In-state competitive standing on Medicaid is more modest: A0427 ranks #2 of 4 providers in-state (67th percentile) and A0429 and A0425 each rank #3 of 4 (33th percentile). That distribution indicates that while the provider is a major Medicaid ALS billing entity, it is not uniquely dominant within the small set of in-state ambulance providers and has peers matching or exceeding it on some measures.

Claims and unit-payment patterns show heavy mileage utilization alongside high-volume ALS transports: A0425 appears as 33.3K Medicare claims and 31.9K Medicaid claims with an average paid/claim of $7 on both payers, while ALS 1 transports (A0427) show $444 avg paid/claim on Medicare and $171 avg paid/claim on Medicaid. This mix implies frequent long or numerous ground transports (large mileage counts) paired with higher per-claim reimbursement for Medicare ALS transports compared with Medicaid.

The provider is relatively recently enumerated: NPI registration date is 2021-04-20 (~5 years ago). Given the high volumes reported since enumeration—particularly the 23.7K Medicaid A0427 claims and 33.3K Medicare A0425 claims—the organization scaled rapidly into high-volume emergency transport operations within a few years of enrollment.

Operational and payer-strategy implication: with A0427 alone accounting for 78.9% of Medicare revenue and 76.2% of Medicaid revenue, the provider’s financials are heavily dependent on advanced life support emergency transports. That dependence, combined with the national "extreme outlier" status on Medicare A0427, suggests any policy, coverage, or rate changes affecting ALS emergency transports would have outsized impact on its revenue and contractual leverage discussions.