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

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

Berkshire Medical Center, Inc (NPI 1295765261)

Key Findings

Field	Value
Entity Type	Organization
Organization	Berkshire Medical Center, Inc
Address	725 North St
City	Pittsfield
State	MA
ZIP	01201
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 4, 2006

Payer Source	Total Paid
Medicaid	$150M
Medicare	$0

This provider is effectively single‑payer in the available data: there is no Medicare billing on file while Medicaid revenue is $150M, indicating Medicaid accounts for the entirety of documented public-payer revenue. Analysts should treat Medicaid patterns here as the primary revenue and utilization signal rather than a combined Medicare/Medicaid mix.

Revenue is highly concentrated in a small set of outpatient and emergency evaluation-and-management codes: the top three Medicaid codes (99284, 99214, 99213) together account for 44.4% of this provider's total Medicaid revenue. Those three codes individually contribute $23.7M (25.0%), $11.8M (12.4%), and $6.6M (7.0%) respectively, signaling that a large share of dollars flow through ED and office/outpatient visits.

The code mix points to a hospital-centered operation with a strong emergency department and high outpatient clinic throughput. 99284 is the single largest Medicaid revenue driver (183.6K claims, $129 avg paid/claim, $23.7M revenue) and the presence of 99214 (90.5K claims, $130 avg paid/claim, $11.8M revenue) and 99213 (57.8K claims, $115 avg paid/claim, $6.6M revenue) reflects major volumes of moderate- and lower-acuity ambulatory care, consistent with a general acute care hospital that runs both ED and high-volume outpatient services.

Competitive standing within the state is exceptional for the top E/M codes: the provider ranks #3 of 827 for 99284 (100th percentile; extreme outlier, far above typical state volume for this code), #29 of 5039 for 99214 (99th percentile; extreme outlier), and #39 of 5303 for 99213 (99th percentile; extreme outlier). These rank/percentile positions indicate dominance or near-dominance statewide for high-volume E/M services and that this facility is a major competitor for ambulatory and ED encounters.

Beyond E/M, the provider shows high activity across diagnostic testing, imaging, and procedural services, evidencing integrated inpatient/outpatient capabilities. Notable examples include 87635 COVID testing (56.6K claims, $39 avg paid/claim, $2.2M revenue; ranks #2 of 717 providers in-state, 100th percentile; extreme outlier), G0463 hospital outpatient clinic visits (153K claims, $24 avg paid/claim, $3.7M revenue), 74177 CT abdomen/pelvis (13.6K claims, $217 avg paid/claim, $3M revenue) and endoscopy codes 43239 and 45380 each contributing ~$1.9M and $1.8M respectively. These data points illustrate breadth across laboratory, imaging, and procedural service lines.

Service-level nuance: the emergency department covers the full acuity spectrum with both high-acuity visits (99285 — $5.7M, 40.7K claims; ranks #35 of 521, 93th percentile; typical, unremarkable volume) and lower-acuity visits (99283 — $4.2M, 32K claims; ranks #44 of 547, 92th percentile; typical, unremarkable volume). This spread indicates the ED is managing both complex and routine emergency presentations rather than focusing narrowly on one acuity band.

Concentration of revenue in a few high-volume E/M codes suggests strategic and financial sensitivity: with 44.4% of Medicaid revenue tied to the top three codes, shifts in outpatient or ED utilization, reimbursement policy, or coding practices for those specific codes could materially affect overall Medicaid revenue. Analysts should flag E/M utilization and payer rate trends as high-impact monitoring areas for this provider.

The provider has an established NPI tenure (NPI enumerated 2006-07-04, ~20 years ago), indicating long-standing operation in the market; combined with the strong state-level ranks and large claim counts, this supports the interpretation of a mature regional hospital with entrenched ED and ambulatory volumes.

Medicaid: Complete Services Breakdown

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

688 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.	183,620	$130	$23.7M
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…	90,500	$130	$11.8M
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…	57,760	$120	$6.6M
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.	40,700	$140	$5.7M
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.	31,960	$130	$4.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	153,030	$20	$3.7M
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	31,230	$110	$3.3M
64405	The provider injects an anesthetic and/or steroid agent into the greater occipital nerve, a nerve arising from the second cranial nerve, also called the optic nerve. Report this code for one or more…	12,280	$250	$3.1M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	13,600	$220	$3M
H0010	Alcohol and/or drug services; sub‑acute detoxification (residential addiction program inpatient)	5,170	$570	$2.9M

Showing 1–10 of 688

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Berkshire Medical Center, Inc — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

688 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	6	10	470	$2,670	$6.3M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	46	90	7,560	$350	$4.2M
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	17	30	1,210	$760	$3.9M
H0010	Alcohol and/or drug services; sub‑acute detoxification (residential addiction program inpatient)	9	30	1,910	$480	$3.5M
S9485	Crisis intervention mental health services, per diem	43	110	1,250	$540	$3.2M
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	9	20	310	$260	$2.1M
J2505	Injection, pegfilgrastim, 6 mg	5	10	650	$1,880	$1.8M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	15	50	1,870	$210	$1.4M
G0378	Hospital observation service, per hour	30	70	7,250	$100	$1.3M
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	8	10	1,720	$430	$1.2M

Showing 1–10 of 688

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Berkshire Medical Center, Inc	MA	Substance Abuse Rehabilitation Facility	$0	$15.4M
Berkshire Faculty Services Inc	MA	Multi-Specialty Clinic/Center	$0	$13.1M
David Jones	MA	Anatomic Pathology & Clinical Pathology Physician	$217.3K	$0
Kalpana Chilukuri	MA	Internal Medicine Physician	$212.6K	$0
Hani Erian	MA	Nephrology Physician	$205.2K	$0
Gregory Malanoski	MA	Infectious Disease Physician	$196.8K	$7.4K
Seetha Muthavarapu	LA	Hospitalist Physician	$200.9K	$0
Maxim Bitunov	MA	Internal Medicine Physician	$184.9K	$3.9K
Suzanne Homan	MA	Hematology (Pathology) Physician	$174.8K	$0
Edmund Hornstein	MA	Specialist	$171.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Commonwealth Of Massachusets	MA	Case Management Agency	$0	$275M
The Brien Center For Mental Health And Substance Abuse Services Inc.	MA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$50.7M
Elder Services Of Berkshire County Inc.	MA	Case Management Agency	$0	$35.9M
Hillcrest Educational Centers Inc	MA	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$21.6M
Berkshire County Arc, Inc.	MA	Foster Care Agency	$0	$19.8M
Ucp Of Western Massachusetts Inc	MA	Early Intervention Provider Agency	$0	$14.9M
Hospicecare In The Berkshires, Inc.	MA	Community Based Hospice Care Agency	$0	$13.8M
Alc Corp	MA	Addiction (Substance Use Disorder) Counselor	$0	$9.5M
Baroco Corporation	MA	Developmentally Disabled Services Day Training Agency	$0	$8.1M
Hillcrest Dental Care, Inc	MA	Dental Clinic/Center	$0	$7.9M

Berkshire Medical Center, Inc — 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