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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Presbyterian Healthcare Services (NPI 1215913470)

Key Findings

Field	Value
Entity Type	Organization
Organization	Presbyterian Healthcare Services
Address	1100 Central Se
City	Albuquerque
State	NM
ZIP	87106
Taxonomy	General Acute Care Hospital
NPI Enumerated	December 20, 2005

Payer Source	Total Paid
Medicaid	$345.3M
Medicare	$0

PRESBYTERIAN HEALTHCARE SERVICES is effectively a Medicaid-focused provider with no Medicare billing on file and $345.3M in total Medicaid revenue. This single-payer skew means analyses of utilization, contracting leverage, and population health impact should be framed primarily around New Mexico Medicaid rather than Medicare benchmarks.

Revenue is highly concentrated in a small number of ED evaluation-and-management codes: the top three Medicaid codes (99285, 99284, 99283) together account for 54.9% of the provider's Medicaid revenue. Individually those codes are $56.3M (25.8%), $46.5M (21.3%), and $17.1M (7.9%) respectively, signaling that a majority of dollars flow from emergency-department encounters.

The code mix and dollar concentrations point to a high-throughput, acute-care operating model centered on emergency services and same-day diagnostics. The prominence of 99285/99284/99283 (high/moderate/low ED complexity) coupled with high volumes for observation G0378 ($4.5M, 2.1%) and rapid diagnostics suggests the facility functions as a major regional ED and short-stay hospital resource.

PRESBYTERIAN is a dominant statewide provider for core ED and several diagnostic codes: 99285 ranks #1 of 71 providers in-state (100th percentile; extreme outlier), 99284 ranks #1 of 76 (100th percentile; extreme outlier), and 99283 ranks #2 of 84 (99th percentile; extreme outlier). These ranks and percentiles indicate market leadership in Medicaid emergency care delivery within New Mexico.

The provider shows heavy diagnostic and lab throughput supporting ED care: 74177 CT abdomen/pelvis ($10.9M, 5.0%) ranks #3 of 56 (96th percentile; notably above typical), 70450 CT head ($5M, 2.3%) ranks #3 of 56 (96th percentile), 87636 multiplex respiratory panel ($9.4M, 4.3%) ranks #1 of 26 (100th percentile; extreme outlier), and U0003 SARS–CoV‑2 high-throughput testing ($6.7M, 3.1%) ranks #2 of 41 (98th percentile; extreme outlier). These items reinforce an image of an ED-centric hospital with substantial imaging and lab capacity.

Several high-volume, low-unit-price laboratory and EKG services also contribute materially to revenue and reflect baseline inpatient/outpatient throughput: 85025 CBC ($3.2M, 1.5%) ranks #1 of 127 (100th percentile; extreme outlier), 80048 BMP ($2.3M, 1.0%) ranks #1 of 50 (100th percentile; extreme outlier), and 93005 EKG ($5.9M, 2.7%) ranks #1 of 46 (100th percentile; extreme outlier). These suggest both scale and breadth in routine diagnostic work that accompanies high ED volumes.

Beyond ED and diagnostics, PRESBYTERIAN bills for inpatient-procedure and specialty services: 43239 endoscopic biopsy ($4.5M, 2.1%) ranks #2 of 53 (98th percentile; extreme outlier) and 47562 laparoscopic cholecystectomy ($2.3M, 1.1%) ranks #1 of 7 (100th percentile; notably above typical). Together with observation revenue (G0378 $4.5M), this indicates the hospital also manages admissions and procedural care rather than serving solely as an ED triage point.

The provider has an established presence with an NPI enumerated on 2005-12-20 (~21 years ago), and the combination of long tenure plus repeated top-state rankings for ED, imaging, lab, and basic procedural codes supports characterization as an entrenched, high-volume Medicaid hospital in Albuquerque and across New Mexico. Analysts should treat PRESBYTERIAN as a major Medicaid system-level asset when modeling regional capacity, ED demand, or Medicaid payment exposure.

Medicaid: Complete Services Breakdown

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

864 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	234,480	$240	$56.3M
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.	258,130	$180	$46.5M
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.	126,910	$140	$17.1M
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.	36,520	$300	$10.9M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	75,580	$120	$9.4M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	152,850	$50	$7M
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	2,110	$3,310	$7M
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…	80,810	$80	$6.7M
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	100,520	$60	$5.9M
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.	31,360	$160	$5M

Showing 1–10 of 864

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Presbyterian Healthcare Services — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

864 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	2	10	2,470	$1,650	$4.1M
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.	1	80	12,050	$160	$3.9M
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.	1	70	6,920	$210	$3.5M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	2	40	3,670	$80	$3.2M
T1017	Targeted case management, each 15 minutes	6	10	3,530	$370	$3M
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	80	10,650	$130	$2.4M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	2	10	260	$2,900	$2.3M
J0585	Injection, onabotulinumtoxina, 1 unit	8	20	810	$520	$1.6M
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.	3	60	3,070	$210	$1.4M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	9	10	290	$320	$1.3M

Showing 1–10 of 864

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Unm Hospital	NM	General Acute Care Hospital	$0	$462.9M
Unm Medical Group Inc	NM	Multi-Specialty Clinic/Center	$0	$113.5M
Dungarvin New Mexico LLC	NM	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$84.6M
Perinatal Associates Of New Mexico, Ltd	NM	Maternal & Fetal Medicine Physician	$0	$62.6M
Optumcare New Mexico LLC	NM	Family Medicine Physician	$0	$23.6M
Unm Hospital	NM	Psychiatric Hospital Unit	$228.5K	$17.6M
Family Eye Care/children's Eye Center Of New Mexico, P.C.	NM	Ophthalmology Physician	$0	$13.3M
Pediatrix Medical Group Of New Mexico, P.C.	NM	Neonatal-Perinatal Medicine Physician	$0	$11.9M
Guardian Flight LLC	NM	Air Ambulance	$372.6K	$6.9M
Climbing Tree Therapy, Inc.	NM	Occupational Therapist	$0	$6.6M

Presbyterian Healthcare Services — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Presbyterian Healthcare Services	NM	Internal Medicine Physician	$0	$240.8M
Centra Medical Group, LLC	VA	Family Medicine Physician	$0	$60.1M
Presbyterian Healthcare Services	NM	Rural Acute Care Hospital	$0	$47.6M
Presbyterian Healthcare Services	NM	Rural Acute Care Hospital	$0	$40.9M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$33.1M
Presbyterian Healthcare Services	NM	General Acute Care Hospital	$0	$21.6M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$20.6M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$8.5M
Christopher Roybal	NM	Ophthalmology Physician	$3.8M	$0
Presbyterian Healthcare Services	NM	Home Health Agency	$0	$3.3M