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

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

Pocatello Health Services, LLC (NPI 1215165485)

Pocatello Health Services, LLC is a general acute care hospital provider located in Pocatello, Idaho. This profile covers 0 Medicare and 72 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Pocatello Health Services, LLC
Address	777 Hospital Way
City	Pocatello
State	ID
ZIP	83201
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 26, 2009

Payer Source	Total Paid
Medicaid	$3.1M
Medicare	$0

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

72 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	16,650	$60	$1M
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…	10,320	$40	$433.6K
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…	10,550	$40	$421.8K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	1,800	$100	$186.9K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	820	$140	$113.6K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	2,380	$40	$95.3K
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…	1,440	$60	$87.7K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	1,940	$40	$75.7K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	680	$90	$58.2K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	310	$190	$57.9K

Showing 1–10 of 72

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Pocatello Health Services, LLC — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

72 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	179	280	1,480	$70	$389.4K
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…	135	210	3,020	$50	$389K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	15	20	110	$840	$224.4K
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…	60	670	740	$40	$193.6K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	22	620	560	$60	$191.8K
99222	The provider sees a patient for an initial 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	200	$90	$158.3K
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…	4	60	1,370	$50	$151.3K
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…	201	230	1,390	$40	$134.8K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	20	20	100	$450	$102.5K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	10	10	20	$340	$94.9K

Showing 1–10 of 72

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pocatello Hospital LLC	ID	General Acute Care Hospital	$0	$6.1M
Samir Elian	MI	Interventional Cardiology Physician	$374.5K	$0
Ram Challapalli	NV	Cardiovascular Disease Physician	$366.7K	$0
Portneuf Asc, LLC	ID	Ambulatory Surgical Clinic/Center	$182.6K	$145.9K
Mark Richards	ID	Clinical Cardiac Electrophysiology Physician	$194.2K	$0
Lee Sandquist	WA	Neurological Surgery Physician	$159.9K	$0
Janet Otto	ID	Clinical Cardiac Electrophysiology Physician	$143.5K	$0
Peter Fort	GA	Pulmonary Disease Physician	$137.8K	$0
Nishit Shah	WI	Cardiovascular Disease Physician	$93.5K	$42.9K
Tushar Acharya	AZ	Cardiovascular Disease Physician	$130K	$6.2K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Moonlight Mountain Recovery, Inc	ID	Substance Abuse Rehabilitation Facility	$0	$17.7M
Pocatello Children & Adolescent Clinic	ID	Pediatrics Physician	$0	$11M
Speech Therapy Services, LLC	ID	Speech-Language Pathologist	$0	$8.5M
Pocatello Chubbuck School District #25	ID	Local Education Agency (LEA)	$0	$7.9M
Facial & Oral Surgery Associates, Inc.	ID	Oral and Maxillofacial Surgery (Dentist)	$0	$6.3M
Health West, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$6.2M
Health West, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$5.9M
Rocky Mountain Physician Group LLC	ID	Emergency Medicine Physician	$0	$5.5M
Community Mental Health	ID	Community/Behavioral Health Agency	$0	$4.3M
Medical Imaging Associates Of Idaho Falls, Inc	ID	Diagnostic Radiology Physician	$0	$4.2M

Pocatello Health Services, LLC — Billing Profile & Reimbursement Data

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Pocatello Health Services, LLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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