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

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

Pyramid Lake Paiute Tribe (NPI 1285740035)

Key Findings

Field	Value
Entity Type	Organization
Organization	Pyramid Lake Paiute Tribe
Address	705 Highway 446
City	Nixon
State	NV
ZIP	89424
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	August 22, 2006

Payer Source	Total Paid
Medicaid	$16.5M
Medicare	$0

This provider is effectively single‑payer in the available data: there is no Medicare billing on file and all reported lifetime revenue is Medicaid at $16.5M. The absence of Medicare activity combined with the Medicaid scale indicates the organization operates primarily within the Medicaid program rather than as a mixed Medicare/Medicaid ambulatory provider.

Revenue is highly concentrated: the precomputed top‑3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, and a single code, T1015, is reported at $16.5M (100.0% of Medicaid revenue). This concentration means overall financial performance for the provider is driven almost entirely by the per‑encounter clinic visit code.

The provider’s taxonomy is Federally Qualified Health Center (FQHC) and the dominant use of T1015 (Clinic visit/encounter, all‑inclusive) is consistent with an FQHC operating under bundled per‑encounter payments. Multiple other procedure codes appear on claims (for example, 90471, G0467, 99214, 92015, and several lab and vision codes) but many of those show $0 avg paid/claim or negligible revenue, which aligns with services being captured inside the all‑inclusive T1015 payment rather than paid separately.

Competitive standing for the primary revenue driver is relatively strong in‑state: T1015 ranks #6 of 58 providers in Nevada (91th percentile), indicating this FQHC is among the larger in‑state reporters for the all‑inclusive clinic visit measure. At the same time, the platform’s label for that code activity remains “typical, unremarkable volume for this code,” suggesting the provider is prominent but operating within expected FQHC encounter volumes rather than as an extreme outlier.

Ancillary and specialty codes are present but materially irrelevant to revenue: for example, 99394 shows 12 claims and $7.2K revenue (0.0% of total Medicaid revenue) while 90471 has 655 claims with $0 avg paid/claim and $0 revenue, and G0467 registers 595 claims with $0 revenue. These patterns indicate that while a range of clinical services (preventive adolescent visits, vaccinations, bundled FQHC visit codes) are delivered and billed on claims, nearly all dollars flow through the T1015 encounter payment.

Operational tenure is long: the provider’s NPI was enumerated 2006-08-22 (~20 years ago), which points to an established presence in the market and likely institutionalized billing practices around FQHC encounter payments. That longevity increases the probability that the observed billing pattern (bundle‑centric Medicaid revenue) reflects an enduring operating model rather than a temporary artifact.

The mix of billed codes suggests a broad primary‑care and allied‑services scope typical for FQHCs: vision-related codes (V2020, V2750, V2755), behavioral‑health psychotherapy (90837), immunizations (90686, 90471), laboratory tests (82948, 83036, 87811), and standard E/M codes (99213/99214/99215) all appear in the claim line list. Given that most of these items report $0 revenue, they likely represent services provided within the bundled encounter rather than separately reimbursed lines, which has implications for utilization analyses that rely on per‑procedure revenue.

For payers and contracting analysts, the dominant role of T1015 (and the fact that top‑3 Medicaid codes account for 100.0% of Medicaid revenue) means financial and utilization oversight should prioritize encounter counts and per‑encounter rates rather than per‑service unit pricing. Audits, capitation negotiations, or rate‑setting discussions will be more informative if they focus on encounter volume, patient mix, and FQHC encounter‑level payments rather than isolated CPT line items that show claims but $0 Medicaid payments.

Medicaid: Competitive Analysis & Benchmarks

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	39,370	$420	$16.5M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	10	$600	$7.2K
0001A	N/A	140	$0	$0
0064A	N/A	150	$0	$0
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	260	$0	$0
36416	In this procedure, the provider pricks the patient’s finger, heel, or ear with a pointed instrument and collects specimen of droplets of blood by pressing the pricking site.	70	$0	$0
80306	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by instrument–assisted direct optical observation, often utilizing immunoassay, to screen for any number of…	20	$0	$0
81003	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dipstick, and shakes off the excess urine. She places the stick onto a mechanical dip stick reader that will…	110	$0	$0
82948	The clinician performs a test to measure the amount of glucose in a patient's blood using a reagent strip test method.	190	$0	$0
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	110	$0	$0

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

Claims Volume vs. Nevada Distribution

Pyramid Lake Paiute Tribe — 0 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nevada

Full comparison — all codes billed, vs. Nevada median

44 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	6	60	2,970	$320	$4M
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which…	30	40	2,310	$90	$623.9K
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…	610	970	360	$80	$139.2K
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…	971	2,250	290	$60	$138K
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…	1,170	2,480	330	$50	$107.6K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	339	450	470	$40	$92K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	216	220	130	$80	$57K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	167	330	240	$60	$55.1K
V2020	Frames, purchases	197	320	360	$30	$53.8K
D0150	Comprehensive oral evaluation – new or established patient	428	470	300	$30	$31.8K

Showing 1–10 of 44

Pyramid Lake Paiute Tribe — Billing Profile & Reimbursement Data

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Pyramid Lake Paiute Tribe — 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

Frequently Asked Questions

References