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.

Geisinger Clinic (NPI 1255382784)

Key Findings

Field	Value
Entity Type	Organization
Organization	Geisinger Clinic
Address	100 N Academy Ave
City	Danville
State	PA
ZIP	17822
Taxonomy	Surgery Physician
NPI Enumerated	May 12, 2006

Payer Source	Total Paid
Medicaid	$74.6M
Medicare	$0

This provider reports no Medicare billing on file and $74.6M in lifetime Medicaid revenue, indicating its public payer activity is effectively concentrated in Medicaid rather than Medicare. The absence of Medicare data means national Medicare competitive position cannot be evaluated from claims, while Medicaid activity defines its measurable scale and service footprint in-state.

Revenue concentration is high: the top three Medicaid codes—99284 ($12.2M), 99214 ($10.4M), and 99213 ($5.3M)—account for 44.8% of this provider's total Medicaid revenue. That precomputed share shows nearly half of Medicaid dollars flow through a small set of E/M codes, signaling dependence on high-volume emergency and outpatient visits for Medicaid revenue.

The code mix points to a broad clinical platform spanning emergency, outpatient, inpatient, imaging, and pathology services rather than a narrow specialty practice. High revenues for emergency department E/M codes (99284 at $12.2M and 99285 at $5.3M), outpatient/office visit E/M codes (99214, 99213, 99215), inpatient subsequent care (99232, 99233), pathology 88305, ECG 93010, and obstetric ultrasound codes 76811/76816 indicate integrated hospital-based and ambulatory service lines.

GEISINGER CLINIC is a statewide leader on many Medicaid codes: multiple top codes rank at the 100th percentile and are labeled as "extreme outlier" (for example, 99284 ranks #2 of 1604 providers in-state (100th percentile; extreme outlier), 99214 ranks #2 of 8157 (100th percentile; extreme outlier), and 99215 ranks #1 of 1210 (100th percentile; extreme outlier)). These rankings characterize the provider as a dominant volume performer for core E/M and acute-care codes in Pennsylvania.

Several specific service lines show exceptional statewide scale. Pathology code 88305 ($2M, ranks #1 of 487 providers, 100th percentile; extreme outlier), routine ECG 93010 ($1.3M, ranks #1 of 1285, 100th percentile; extreme outlier), and obstetric ultrasound 76811 ($1.2M, ranks #1 of 104, 100th percentile; extreme outlier) each rank at the top of in-state peers, indicating large lab, cardiac diagnostic, and maternal-fetal imaging operations within the organization.

High claim volumes reinforce the operational scale: for example, 99284 has 194.1K claims, 99214 has 212.4K claims, and 93010 shows 213.4K claims. Those claim counts, paired with the ranked percentiles, imply sustained high throughput across emergency, outpatient, and diagnostic services rather than episodic spikes.

Several higher-acuity and specialized services are also prominent in the Medicaid mix, including critical care 99291 ($908.8K, ranks #5 of 252, 98th percentile; extreme outlier) and echo 93306 ($940.1K, ranks #1 of 551, 100th percentile; extreme outlier). The presence of both high-acuity and routine diagnostic codes suggests capacity for inpatient/critical care alongside ambulatory diagnostics.

The NPI has been enumerated since 2006-05-12 (~20 years ago), indicating long-standing participation in public programs; combined with the provider's concentrated Medicaid revenue and pervasive 100th-percentile rankings, this tenure supports the interpretation of an established, high-volume Medicaid-focused health system presence in Pennsylvania.

Medicaid: Complete Services Breakdown

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

358 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.	194,070	$60	$12.2M
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…	212,420	$50	$10.4M
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…	161,400	$30	$5.3M
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.	62,270	$90	$5.3M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	57,940	$70	$4.1M
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	26,550	$120	$3.1M
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.	48,360	$50	$2.4M
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…	54,940	$40	$2M
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…	20,670	$90	$1.8M
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	20,210	$80	$1.6M

Showing 1–10 of 358

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

Geisinger Clinic — 24 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

358 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J2357	Injection, omalizumab, 5 mg	3	10	320	$1,550	$1.6M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	3	10	150	$440	$865.3K
J7298	Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg	6	20	100	$680	$589.6K
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…	117	410	1,130	$60	$455.4K
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.	2	1,600	270	$120	$409.7K
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.	9	1,060	150	$130	$405.4K
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	37	60	430	$200	$354.2K
H0004	Behavioral health counseling and therapy, per 15 minutes	863	1,410	820	$160	$353.5K
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies	7	30	180	$570	$331.3K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	529	540	1,490	$50	$316.4K

Showing 1–10 of 358

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jefferson University Physicians	PA	General Practice Physician	$0	$30.8M
Geisinger Pharmacy LLC	PA	Pharmacy	$0	$26.7M
The Milton S. Hershey Medical Center Physicians Group	PA	Sports Medicine (Neuromusculoskeletal Medicine) Physician	$0	$26.6M
Geisinger Clinic - Outpatient Psych	PA	Counselor	$0	$19.6M
Geisinger Clinic	PA	Diagnostic Radiology Physician	$0	$14.9M
Geisinger Clinic	PA	Family Medicine Physician	$0	$13.4M
Geisinger Bloomsburg Hospital	PA	General Acute Care Hospital	$0	$7.2M
Geisinger Wyoming Valley Medical Center	PA	General Acute Care Hospital	$0	$7M
Geisinger Clinic	PA	Addiction (Substance Use Disorder) Psychologist	$0	$5.8M
Ravi Pandit	OK	Retina Specialist (Ophthalmology) Physician	$2.5M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Geisinger Medical Center	PA	General Acute Care Hospital	$0	$27.8M
Geisinger Medical Center	PA	Air Ambulance	$0	$6.6M
George Lin	PA	Anatomic Pathology & Clinical Pathology Physician	$1.2M	$0
Christopher Cessna	PA	Ophthalmology Physician	$1.2M	$0
Rasoul Mokabberi	PA	Cardiovascular Disease Physician	$613.5K	$590
Bryan Martin	PA	Cardiovascular Disease Physician	$449.7K	$770
Frank Mercho	PA	Diagnostic Radiology Physician	$423.9K	$0
Brian Goldner	PA	Diagnostic Radiology Physician	$310.3K	$0
Jeffrey Crosby	PA	Diagnostic Radiology Physician	$299.3K	$0
Andrew Pohl	PA	Neuroradiology Physician	$287K	$0

Geisinger Clinic — 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