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.

Appalachian Regional Healthcare, Inc. (NPI 1306842521)

Key Findings

Field	Value
Entity Type	Organization
Organization	Appalachian Regional Healthcare, Inc.
Address	81 Ball Park Road
City	Harlan
State	KY
ZIP	40831
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 22, 2005

Payer Source	Total Paid
Medicaid	$55.1M
Medicare	$0

APPALACHIAN REGIONAL HEALTHCARE, INC. reports $55.1M in lifetime Medicaid revenue and has no Medicare billing on file, making its recorded payer footprint effectively single‑payer Medicaid rather than a mixed Medicare/Medicaid provider. The absence of Medicare activity suggests payer strategy and revenue risk are concentrated on state Medicaid contracts and beneficiaries rather than on traditional Medicare volumes.

Revenue concentration is high: the precomputed top three Medicaid codes (99284, 99285, 74176) together account for 48.3% of the provider's total Medicaid revenue. This indicates nearly half of Medicaid dollars flow from a narrow set of emergency‑ and imaging‑related services rather than from a broad mix of elective inpatient or specialty procedural revenue.

The code mix and top revenue drivers point to an ED‑and‑acute diagnostic hospital profile: 99284 ($10.2M, 24.8%) and 99285 ($4.9M, 12.0%) are the largest contributors, signaling heavy emergency department activity with moderate to high complexity visits. Complementing that ED volume, 74176 ($4.7M, 11.5%) is a top imaging generator (CT abdomen/pelvis without contrast), which together with high claims counts for CT head (70450) and observation (G0378) suggests the hospital operates as a regional emergency/diagnostic hub.

Competitive standing by code is mixed: for emergency E/M the provider ranks #59 of 282 for 99284 (79th percentile) and #72 of 239 for 99285 (70th percentile), both labeled as typical, unremarkable volumes compared with in‑state peers, indicating moderate ED market share rather than dominance. In contrast, the provider shows relatively stronger positioning on CT abdomen/pelvis (74176 rank #25 of 165, 85th percentile, typical, unremarkable volume) and on observation services (G0378 rank #12 of 87, 87th percentile), implying above‑average imaging and observation activity versus peers.

A few specific service areas are clear outliers in state comparisons: 94640 (oxygen/airway therapy) ranks in the 93rd percentile and is described as notably above typical state volume for this code, and phlebotomy 36415 ranks in the 98th percentile and is described as notably above typical state volume for this code. High relative volumes in these operationally fundamental services (oxygen therapy and specimen collection) suggest heavy throughput of acute medical patients and significant downstream lab and support service demand.

Clinical support services and therapy contribute meaningful secondary revenue: CPTs for lab panels and tests (80053, 85025, 84443, 80061) and therapy codes (97110, 97530) together appear across the top 25, with many positioned in the 80th–93rd percentiles but labeled typical, unremarkable volume for those codes. This pattern indicates robust ancillary service lines (laboratory, imaging, rehabilitation) that complement ED and observation care rather than replacing them as primary revenue engines.

Operational risk and business implications stem from the top‑code concentration: with 48.3% of Medicaid revenue tied to 99284, 99285, and 74176, shifts in ED visit patterns, Medicaid reimbursement policy for ED/CT services, or regional competition for emergency imaging could materially affect overall revenue. The provider should be viewed as sensitive to policy or utilization changes affecting emergency care and diagnostic imaging.

The organization has an established presence: its NPI was enumerated on 2005-06-22 (~21 years ago), indicating long‑term operation in the community. Combined with the mix of high throughput services and several above‑typical state volumes, the tenure supports a mature acute care facility focused on emergency, observation, and diagnostic operations within Kentucky's Medicaid ecosystem.

Medicaid: Complete Services Breakdown

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

301 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.	24,200	$420	$10.2M
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.	10,460	$470	$4.9M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	7,180	$660	$4.7M
G0378	Hospital observation service, per hour	12,370	$380	$4.7M
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.	18,650	$100	$1.9M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	4,940	$280	$1.4M
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	52,770	$20	$1.2M
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.	1,310	$800	$1M
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.	13,670	$80	$1M
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…	68,990	$10	$827.9K

Showing 1–10 of 301

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

Appalachian Regional Healthcare, Inc. — 1 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

301 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	59	280	7,150	$150	$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.	72	240	4,710	$150	$2.6M
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.	77	280	5,700	$120	$2M
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.	99	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	12	90	2,770	$190	$1.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	45	80	7,740	$30	$1.1M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	25	170	2,610	$250	$1M
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…	43	50	2,340	$200	$829.7K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	46	110	8,390	$50	$749.1K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	74	340	2,700	$40	$673.3K

Showing 1–10 of 301

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Appalachian Regional Healthcare, Inc	KY	Rural Health Clinic/Center	$0	$8M
H & A Counseling, Psc	KY	Mental Health Counselor	$0	$5.8M
Horizon Adult Health Care LLC	KY	Occupational Therapist	$0	$3.8M
Air Evac Ems Inc.	KY	Air Ambulance	$550.9K	$2.2M
Abdulkader Dahhan	KY	Internal Medicine Physician	$200.5K	$2.4M
Mercy Ambulance Of Evansville Inc	KY	Ambulance	$567.9K	$819.9K
Jayaramakrishna Depa	KY	Nephrology Physician	$149.2K	$0
Gregory Dye	KY	Family Medicine Physician	$72K	$0
Opal Prevatt	KY	Internal Medicine Physician	$52.8K	$0
Syed Raza	KY	Psychiatry Physician	$49.5K	$0

Appalachian Regional Healthcare, Inc. — Billing Profile & Reimbursement Data

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Appalachian Regional Healthcare, 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$107.9M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$38.9M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$33.4M
Union Associated Physicians Clinic, LLC	IN	Family Medicine Physician	$0	$31.1M
Appalachian Regional Healthcare, Inc.	KY	Critical Access Hospital	$0	$26.9M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$26.8M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Appalachian Regional Healthcare, Inc	WV	General Acute Care Hospital	$0	$18.3M
Appalachian Regional Healthcare, Inc.	KY	Critical Access Hospital	$0	$17.9M
Mercy Health System Corporation	WI	Multi-Specialty Clinic/Center	$0	$13.2M