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

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

Southwestern Vermont Medical Center Inc. (NPI 1205865789)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southwestern Vermont Medical Center Inc.
Address	100 Hospital Dr
City	Bennington
State	VT
ZIP	05201
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 30, 2006

Payer Source	Total Paid
Medicaid	$5.1M
Medicare	$0

This provider is effectively single‑payer in the available files: there is no Medicare billing on file while total Medicaid revenue is $5.1M, so Medicaid accounts for the entirety of recorded federal-program revenue in this dataset. Analysts should treat comparisons and capacity in the context of a Medicaid‑centered billing profile rather than a dual‑payer hospital footprint.

Revenue is highly concentrated in a small number of Medicaid codes: the top three codes (99284, 99283, U0003) account for 53.9% of the provider's total Medicaid revenue. Those top-line contributors are 99284 at $1.2M (24.4%), 99283 at $990.9K (20.8%), and U0003 at $414.2K (8.7%), indicating a narrow set of services driving most Medicaid dollars.

The code mix points to an emergency‑department–centric acute care operation: the two largest revenue drivers are ED E/M codes 99284 and 99283, and 99285 also appears in the top list at $354.1K (7.4%). High claim volumes for these E/M codes (e.g., 24.2K claims for 99283 and 21.1K for 99284) imply the facility manages substantial ED throughput, with a mix of low‑to‑moderate and some higher acuity presentations.

Competitive standing within Vermont is strong for several emergency and testing codes. 99283 ranks #2 of 28 providers in‑state (96th percentile; noted as 'notably above typical' state volume) and 99284 ranks #4 of 31 (90th percentile; typical), while the COVID NAAT code U0003 ranks #1 of 10 providers in‑state (100th percentile; 'notably above typical'), establishing the hospital as a leading statewide provider for both ED visits and SARS‑CoV‑2 testing.

The provider shows robust in‑house laboratory and diagnostic capacity: multiple lab and test codes rank at the top of state peers, including 80053 at $137K (rank #1 of 19, 100th percentile), 84443 at $104K (rank #1 of 9, 100th percentile), 85025 at $74.8K (rank #1 of 20, 100th percentile), and 84484 at $67.9K (rank #1 of 7, 100th percentile). These consistent #1 ranks across diverse lab codes suggest the hospital performs a high share of its own outpatient and ED laboratory work rather than referring it externally.

Outpatient infusion and medication administration are material revenue contributors: 96374 appears at $258.6K (5.4% of Medicaid revenue) and ranks #1 of 6 providers in‑state (100th percentile; 'notably above typical'), indicating notable volume of rapid IV medication administration either through the ED or an outpatient infusion capability. This supports the characterization of the site as providing both urgent/ED care and some procedural or therapeutic outpatient services.

COVID‑era and proprietary respiratory testing are prominent in the top code mix: U0003 ($414.2K, 8.7%, rank #1 of 10, 100th percentile), U0005 ($97.6K, 2.1%, rank #1 of 6, 100th percentile), and PLA code 0202U ($26.7K, 0.6%, rank #1 of 1) all appear in the top 25. The presence of multiple SARS‑CoV‑2 and respiratory panel codes among leading revenue drivers signals sustained high testing volumes during the period captured by the Medicaid data.

The provider is an established community hospital by tenure and taxonomy: NPI enumerated 2006-06-30 (~20 years ago) and taxonomy is General Acute Care Hospital, which aligns with the observed ED, inpatient E/M, lab, and infusion service mix. That history and taxonomy support interpreting the billing patterns as those of a long‑standing acute care facility with significant Medicaid ED and lab activity.

Medicaid: Complete Services Breakdown

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

90 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.	21,070	$60	$1.2M
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.	24,170	$40	$990.9K
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…	6,370	$70	$414.2K
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.	4,850	$70	$354.1K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	15,580	$20	$280.4K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	1,090	$240	$258.6K
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.	6,230	$20	$137K
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.	1,720	$70	$127.4K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	4,620	$20	$110.9K
84443	The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the…	2,210	$50	$104K

Showing 1–10 of 90

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Southwestern Vermont Medical Center Inc. — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

90 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	5	10	16,150	$20	$239.2K
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.	4	30	830	$40	$232.2K
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.	2	30	1,150	$30	$147K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	3	10	1,680	$30	$137K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	6	20	630	$30	$118.5K
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.	4	30	190	$50	$104.3K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	7	10	510	$40	$103.2K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	2	10	80	$30	$98.8K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	153	320	760	$20	$88.2K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	2	10	60	$30	$85.4K

Showing 1–10 of 90

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southwestern Vermont Medical Center Inc.	VT	Internal Medicine Physician	$0	$2.9M
Southwestern Vermont Medical Center, Inc	VT	General Practice Physician	$0	$665.4K
Augustin Delago	NY	Cardiovascular Disease Physician	$501.1K	$0
Brion Winston	NY	Cardiovascular Disease Physician	$419.1K	$8.7K
Robert Giering	VT	Physical Medicine & Rehabilitation Physician	$397K	$0
Lixia Ellis	VT	Dermatology Physician	$283.1K	$0
Scott Rogge	VT	Cardiovascular Disease Physician	$239.5K	$0
Joseph Choma	NY	Gastroenterology Physician	$200.9K	$0
Thomas Sterling	VT	Emergency Medicine Physician	$118.3K	$0
Matthew Vernon	VT	Radiation Oncology Physician	$114.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
United Counseling Service Of Bennington County, Inc.	VT	Developmental Disabilities Clinic/Center	$0	$72.5M
Vermont Permanency Initiative, Inc.	VT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$27.9M
Savida Health, PC	VT	Addiction Medicine (Internal Medicine) Physician	$0	$12M
Sunrise Family Resource Center	VT	Social Worker	$0	$7M
Seall Inc	VT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$6.6M
United Counseling Service Of Bennington County, Inc.	VT	Clinic/Center	$0	$6M
Town Of Bennington Rescue Squad, Inc.	VT	Land Ambulance	$683.4K	$2.7M
Oral And Facial Surgery Associates,plc	VT	Oral and Maxillofacial Surgery (Dentist)	$0	$1.8M
Brookside Pediatrics & Adolescent Medicine PLLC	VT	Pediatrics Physician	$0	$1.2M
Vermont Family Dental Plc	VT	Dental Clinic/Center	$0	$1.1M

Southwestern Vermont Medical Center Inc. — 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