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

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

Childrens Hospital Of Philadelphia (NPI 1215921457)

Field	Value
Entity Type	Organization
Organization	Childrens Hospital Of Philadelphia
Address	34th And Civic Center Blvd
City	Philadelphia
State	PA
ZIP	19104
Taxonomy	Children's Hospital
NPI Enumerated	September 2, 2005

Payer Source	Total Paid
Medicaid	$286.9M
Medicare	$0

Key Findings

CHILDRENS HOSPITAL OF PHILADELPHIA is effectively a Medicaid-focused provider: there is no Medicare billing on file and lifetime Medicaid revenue is $286.9M, which makes Medicaid the dominant (in practice sole) payer in the available claims data. Its NPI was enumerated 2005-09-02 (~21 years ago), indicating long-standing activity in the market.

Revenue is highly concentrated in emergency department evaluation-and-management services: the precomputed top‑3 Medicaid codes account for 56.3% of the provider’s total Medicaid revenue, driven by 99283 ($54.8M, 24.0%), 99284 ($38.4M, 16.8%), and 99285 ($35.6M, 15.6%). This concentration signals that ED encounters are the primary Medicaid revenue engine for the organization.

The operational profile points to a large pediatric emergency and observation center: high volumes for 99283 (91.8K claims, $597 avg, ranks #2 of 1063, 100th percentile, extreme outlier) together with 99284 and 99285 and a substantial G0378 footprint (24.1K claims, $872 avg, $21M, 9.2% of Medicaid revenue; ranks #1 of 149, 100th percentile, extreme outlier) indicate sustained inpatient observation and ED throughput capacity. These code patterns are consistent with tertiary pediatric acute care and short-stay observation services rather than a primarily ambulatory clinic mix.

The provider also shows a strong specialty infusion and high-cost drug profile: J1745 (6.2K claims, $2587 avg, $16M, 7.0% of Medicaid revenue; ranks #1 of 18, 100th percentile, extreme outlier) and J1561 (3.3K claims, $3119 avg, $10.2M, 4.5%; ranks #1 of 4, 100th percentile) indicate significant infusion therapy volume and drug spend, consistent with management of complex chronic pediatric conditions and on-site infusion services. These billed medication codes signal a capability to deliver biologic and immune globulin therapies at scale.

Imaging and cardiac diagnostics are material service lines: notable volumes and revenues appear for echocardiography and MRI (93306 4.8K claims $3.8M; 93303 5.8K claims $3.6M; 93325 17.4K claims $2.3M; 70553 3.5K claims $3.5M; 70551 3.6K claims $2.5M), with percentile ranks in the high 90s. This mix supports a tertiary subspecialty role in pediatric cardiology and advanced imaging rather than basic imaging only.

Surgical and procedural pediatrics are significant: procedure codes such as 69436 (2.6K claims, $3.6M; ranks #2 of 50, 98th percentile), 43239 (2K claims, $3.5M; ranks #5 of 292, 99th percentile), and 42820 (989 claims, $2.1M; ranks #3 of 28, 93rd percentile) reflect steady volumes in ENT, endoscopy, and pediatric operative care. Those rankings indicate volumes well above typical state providers and reinforce its role as a high-throughput pediatric surgical center.

The provider occupies dominant statewide positions on a number of codes, frequently appearing as an extreme outlier: examples include 99283 (100th percentile, extreme outlier), G0378 (100th percentile, extreme outlier), J1745 (100th percentile, extreme outlier), J3490 (48.8K claims, $3.2M; ranks #1 of 156, 100th percentile, extreme outlier), and 87635 (66.7K claims, $2.1M; ranks #1 of 375, 100th percentile, extreme outlier). These rank/percentile patterns characterize the hospital as a major statewide hub for many pediatric services rather than a modest local participant.

Ancillary and behavioral health services are also substantial within the Medicaid mix: psychotherapy 90837 shows 34.2K claims and $8M in revenue (3.5% of Medicaid revenue; ranks #13 of 555, 98th percentile), and high testing volumes are reflected in 85025 (60.7K claims, $1.6M) and 80053 (46.3K claims, $1.4M). Together these items indicate a comprehensive service portfolio that includes behavioral health, laboratory, and diagnostic support aligned with large outpatient/inpatient throughput.

Medicaid: Complete Services Breakdown

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

540 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.	91,800	$600	$54.8M
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.	65,230	$590	$38.4M
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.	59,810	$600	$35.6M
G0378	Hospital observation service, per hour	24,080	$870	$21M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	6,190	$2,590	$16M
J1561	Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg	3,280	$3,120	$10.2M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	34,160	$230	$8M
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…	4,810	$780	$3.8M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	2,560	$1,420	$3.6M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	5,800	$620	$3.6M

Showing 1–10 of 540

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Childrens Hospital Of Philadelphia — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

540 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1561	Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg	1	10	1,490	$2,430	$3.8M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	4	10	770	$1,290	$1.6M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1	20	350	$1,720	$1.6M
G0378	Hospital observation service, per hour	1	150	510	$870	$1.4M
T1015	Clinic visit/encounter, all-inclusive	121	1,690	760	$170	$1.2M
J3380	Injection, vedolizumab, intravenous, 1 mg	8	10	140	$2,680	$758.7K
P9040	Red blood cells, leukocytes reduced, irradiated, each unit	2	10	940	$820	$738.7K
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.	135	210	730	$40	$689.7K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	13	560	1,400	$90	$485.7K
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…	65	410	1,130	$60	$455.4K

Showing 1–10 of 540

Related Providers

Other providers that share a Tax Identification Number (TIN) with Childrens Hospital Of Philadelphia, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital Of Philadelphia	PA	Durable Medical Equipment & Medical Supplies	$0	$27.6M
Children's Hospital Of Philadelphia	PA	Home Infusion Agency	$0	$23.1M
The Children's Hospital Of Philadelphia	PA	Pediatrics Physician	$0	$11.9M
Children's Hospital Of Philadelphia	PA	Pediatrics Physician	$0	$5.7M
Children's Hospital Of Philadelphia	PA	Pediatrics Physician	$0	$5.5M
Saifuddin Mama	NJ	Obstetrics & Gynecology Physician	$24.1K	$0
Meghna Patel	PA	Neuromusculoskeletal Medicine & OMM Physician	$13.1K	$0

Nearby Providers

Other providers in the same ZIP code as Childrens Hospital Of Philadelphia, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Trustees Of The University Of Pennsylvania	PA	General Acute Care Hospital	$0	$84M
House House Rehabilitation Services	PA	Community/Behavioral Health Agency	$0	$32.8M
Childrens Health Care Associates, Inc	PA	Pediatric Emergency Medicine (Emergency Medicine) Physician	$0	$24.2M
Presbyterian Medical Center Of The University Of Pennsylvania Health S	PA	General Acute Care Hospital	$0	$23.3M
University Of Penn-medical Group	PA	Emergency Medicine Physician	$0	$21.5M
University Of Penn-medical Group	PA	Diagnostic Radiology Physician	$0	$17.7M
Horizon House, Inc.	PA	Community/Behavioral Health Agency	$0	$13.9M
Tricounty Medical Equipment And Supply, LLC	PA	Durable Medical Equipment & Medical Supplies	$0	$13.1M
Dunbar Strategic Consulting Group	PA	Community/Behavioral Health Agency	$0	$10.8M
Intercultural Family Services, Inc.	PA	Health Service Psychologist	$0	$10.7M

Childrens Hospital Of Philadelphia — 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