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

Why is the Medicaid comparison limited to Wisconsin 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. Wisconsin (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 Wisconsin, Inc. (NPI 1245308626)

Field	Value
Entity Type	Organization
Organization	Childrens Hospital Of Wisconsin, Inc.
Address	9000 W Wisconsin Ave
City	Milwaukee
State	WI
ZIP	53226
Taxonomy	Pediatrics Physician
NPI Enumerated	December 1, 2006

Payer Source	Total Paid
Medicaid	$19M
Medicare	$0

Key Findings

CHILDRENS HOSPITAL OF WISCONSIN, INC. (MILWAUKEE, WI) is effectively a Medicaid-focused billing entity with $19M in lifetime Medicaid revenue and no Medicare billing on file. This makes the provider functionally single-payer in the dataset and concentrates analytic attention on Medicaid program performance and contract arrangements rather than Medicare exposure.

Revenue is extremely concentrated: the precomputed top three Medicaid codes account for 100.0% of this provider's total Medicaid revenue, with T2023 alone representing $18.4M (96.8%). That level of concentration indicates the organization’s financial performance is tightly tied to a narrow set of case-management and care-planning services.

The code mix and taxonomy (Pediatrics Physician) point to a primary operational emphasis on ongoing case management and care coordination for pediatric populations: T2023 is described as Targeted case management (per month), and it dominates revenue. This suggests the provider operates a substantial program-level case management operation rather than generating revenue primarily from high-volume procedural or inpatient E/M services.

G0506 contributes $598.8K (3.2% of Medicaid revenue) and the provider ranks #1 of 11 in-state for this code, which is labeled notably above typical state volume. That ranking, along with the code’s description (comprehensive assessment and care planning for chronic care management), implies an organizational capability in structured chronic care planning that supplements the monthly targeted case management services.

Newborn/newborn follow-up E/M codes (99462 and 99460) generate trivial revenue ($4.3K and $2.7K respectively, 0.0% of Medicaid revenue) and occupy modest-to-low state ranks (99462 at #4 of 12, 99460 at #40 of 54). These entries indicate the provider does bill for newborn evaluations but that neonatal E/M services are not material contributors to its Medicaid revenue base.

Competitive standing is nuanced: for T2023 the provider ranks #1 of 4 in-state (100th percentile) but the pre-labeled characterization is typical, unremarkable volume, suggesting leadership within a small peer group rather than dominance derived from unusually high volume. By contrast, for G0506 the provider is both #1 of 11 and categorized as notably above typical state volume, indicating a clearer competitive advantage in comprehensive chronic care assessment and planning within the state.

The NPI was enumerated on 2006-12-01 (~20 years ago), signaling a long-tenured presence in the market. This longevity supports the expectation of established program infrastructure for case management and may reflect sustained Medicaid contracting relationships.

From a payer/contracting perspective, the profile reads as a specialist provider of pediatric targeted case management and chronic care planning services; this creates both opportunity and risk—opportunity to partner around case management programs where the provider shows market leadership, and risk tied to their heavy dependency on T2023 reimbursement which could be sensitive to policy or rate changes. Analysts should prioritize monitoring of targeted case management utilization and G0506 activity when evaluating future engagements with this entity.

Medicaid: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2023	Targeted case management; per month	43,730	$420	$18.4M
G0506	Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)	540	$1,120	$598.8K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	140	$30	$4.3K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	30	$110	$2.6K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	40	$40	$1.4K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Childrens Hospital Of Wisconsin, Inc. — 2 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2023	Targeted case management; per month	1	10	10,060	$410	$6.6M
G0506	Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)	1	10	30	$650	$55.7K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	40	50	50	$100	$25.6K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	65	110	60	$30	$10.8K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	4	10	60	$30	$4.6K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital Of Wisconsin, Inc.	WI	Children's Hospital	$0	$262.3M
Children's Hospital And Health System, Inc.	WI	Urgent Care Clinic/Center	$0	$17.7M
Children's Hospital	LA	Specialist	$0	$9.8M
Children's Hospital Of Wisconsin, Inc.	WI	Children's Hospital	$0	$3.4M
Children's Health System	WI	Urgent Care Clinic/Center	$0	$2.3M
Children's Health System, Inc.	WI	Urgent Care Clinic/Center	$0	$1.8M
Adam Quinn	MS	Ophthalmology Physician	$620.3K	$0
Charles Richardson	MS	Ophthalmology Physician	$575.5K	$0
Todd Williamson	MS	Ophthalmology Physician	$543.8K	$0
Ted Harden	MS	Optometrist	$93.5K	$293.3K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Froedtert Memorial Lutheran Hospital, Inc.	WI	General Acute Care Hospital	$0	$157.8M
The Medical College Of Wisconsin, Inc.	WI	Internal Medicine Physician	$17.8K	$74.8M
Emergency Medicine Specialists, S.c.	WI	Emergency Medicine Physician	$0	$35.3M
Wisconsin Diagnostic Laboratories LLC	WI	Clinical Medical Laboratory	$2.3M	$22.7M
Option Care Home Care Inc	WI	Pharmacy	$0	$12.5M
Curative Care Network, Inc.	WI	Rehabilitation Clinic/Center	$0	$12.2M
Children's Specialty Group, Inc.	WI	Pediatrics Physician	$0	$10.4M
Brian Blocher	WI	Oral & Maxillofacial Surgery (D.M.D.)	$0	$5.5M
Nicholas Tosi	WI	Retina Specialist (Ophthalmology) Physician	$4.9M	$0
Wisconsin Laser And Surgery Center LLC	WI	Ambulatory Surgical Clinic/Center	$1.1M	$2.9M

Childrens Hospital Of Wisconsin, Inc. — Billing Profile & Reimbursement Data

Sign up for Childrens Hospital Of Wisconsin, Inc. — Billing Profile & Reimbursement Data policy alerts

Childrens Hospital Of Wisconsin, Inc. — Billing Profile & Reimbursement Data

Sign up for Childrens Hospital Of Wisconsin, Inc. — Billing Profile & Reimbursement Data policy alerts

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