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

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

Beverly M Gaines, Md & Associates, Psc (NPI 1265512719)

Beverly M Gaines, Md & Associates, Psc is a pediatrics physician provider located in Louisville, Kentucky. This profile covers 0 Medicare and 90 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	Beverly M Gaines, Md & Associates, Psc
Address	801 Barret Ave
City	Louisville
State	KY
ZIP	40204
Taxonomy	Pediatrics Physician
NPI Enumerated	October 17, 2006

Payer Source	Total Paid
Medicaid	$3.6M
Medicare	$0

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

90 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…	10,090	$50	$454K
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…	9,670	$40	$348K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	8,750	$40	$341.3K
99173	The provider checks the eyesight in both eyes of a pediatric patient by asking him to read letters of varying sizes on a standard chart, such as a Snellen’s chart, which he keeps 20 feet away from…	7,700	$40	$331K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	4,080	$80	$305.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,820	$80	$290.2K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	3,510	$70	$252.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,830	$80	$228.8K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	1,390	$120	$161.4K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	2,460	$50	$120.4K

Showing 1–10 of 90

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Beverly M Gaines, Md & Associates, Psc — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

90 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	52	80	260	$270	$358.5K
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…	565	3,340	1,020	$30	$296K
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…	207	2,460	580	$40	$245K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	50	230	720	$60	$180.1K
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	56	80	480	$50	$177.8K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	42	260	540	$70	$176.6K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	110	310	3,500	$10	$149.9K
95117	The provider injects the patient with allergenic extracts to desensitize the patient to the allergen; the patient receives 2 or more injections at a single visit.	49	100	580	$10	$119.8K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	62	190	360	$60	$119.3K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	38	400	800	$30	$113.3K

Showing 1–10 of 90

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Louisville Jefferson County Metro Government	KY	Land Ambulance	$2.1M	$12M
Kentucky Recovery Limited Liability Company	KY	Methadone Clinic	$0	$2.8M
Jignesh Desai	KY	Internal Medicine Physician	$361.7K	$0
Walgreen Co	KY	Pharmacy	$131.4K	$170
Ruth Gay Lawton	KY	Gerontology Nurse Practitioner	$83.8K	$0
Sylvia Cole	KY	Internal Medicine Physician	$61.4K	$0
Joshua Bentley	KY	Family Medicine Physician	$52.8K	$0
Priscilla Villaroman	KY	Internal Medicine Physician	$52K	$0
Mark Siefring	KY	Internal Medicine Physician	$50.8K	$0
Shastine Sharp	KY	Family Medicine Physician	$48.3K	$0

Beverly M Gaines, Md & Associates, Psc — Billing Profile & Reimbursement Data

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Beverly M Gaines, Md & Associates, Psc — 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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