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.

Cumberland Family Medical Center Inc (NPI 1306873500)

Key Findings

Field	Value
Entity Type	Organization
Organization	Cumberland Family Medical Center Inc
Address	360 Keen Street
City	Burkesville
State	KY
ZIP	42717
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	June 26, 2006

Payer Source	Total Paid
Medicaid	$72.3M
Medicare	$0

This entity is effectively a single‑payer, Medicaid‑dependent provider: there is no Medicare billing on file while lifetime Medicaid revenue is $72.3M, indicating the organization’s financial footprint is driven almost entirely by Medicaid reimbursements. Its taxonomy as a Federally Qualified Health Center (FQHC) aligns with that payer concentration and the presence of FQHC‑specific codes in the claims mix.

Medicaid revenue is highly concentrated in a small set of evaluation-and-management (E/M) codes: the top three Medicaid codes (99213, 90832, 99211) together account for 60.6% of the provider’s total Medicaid revenue. The single largest contributor is 99213 ($29.4M, 44.5% of Medicaid revenue), followed by 90832 ($5.7M, 8.6%) and 99211 ($4.9M, 7.5%), signaling heavy reliance on routine office visits and related encounters for revenue.

Clinical service mix shows a primary-care and community health orientation: high revenue and claim volumes for 99213 ($29.4M), 99211 ($4.9M), 99212 ($2.1M), and 99214 ($1.1M) indicate the center primarily delivers established‑patient office visits and low-to-moderate complexity ambulatory care. The listing of G0467 (FQHC visit) with substantial claims further supports that these visits are being delivered in an FQHC model that bundles typical outpatient services.

Behavioral health and care management are prominent components of the operation: psychotherapy codes 90832 ($5.7M), 90834 ($1.4M), and 90837 ($1.2M) contribute materially to Medicaid revenue, and targeted case management T2023 generates $3M (4.6% of Medicaid revenue). These data indicate integrated behavioral-health services and monthly case‑management billing are important service lines for this provider.

Testing, infectious‑disease screening and vaccination services are offered at scale: COVID/flu testing and other point‑of‑care diagnostics show major volumes (87428: $2.6M; 87880: $1.3M; 87811: $817.5K; 87804: $553.9K) and multiple vaccination codes appear in the top list (90686, 90460, 90471). The high volumes for 87428 and related lab codes suggest on‑site testing capacity and active use of diagnostic services in outpatient workflows.

Pediatric and preventive services are a significant revenue stream: well‑visit codes 99392 ($1.9M), 99391 ($1.8M), 99393 ($1.7M) and preventive dental D1120 ($926.1K) and D0150 ($550.3K) indicate a broad pediatric preventive program including immunizations and child dental prophylaxis. The presence of large claims counts for vaccine administration codes (90460, 90471) reinforces a strong focus on childhood immunization and preventive care.

The provider is a dominant in‑state performer on many measures: 99213 ranks #1 of 3339 providers in‑state (100th percentile; extreme outlier), 87428 ranks #1 of 210 (100th percentile; extreme outlier), and numerous other codes (e.g., 99211, 99392, 99391, 99393, 90686) rank in the 100th percentile or similarly high percentiles. These rankings characterize the center as a major statewide volume leader for primary care visits, pediatric preventive services, testing, and certain vaccinations.

Operational tenure and scale are established: the NPI was enumerated on 2006-06-26 (~20 years ago), and the provider’s lifetime Medicaid receipts of $72.3M combined with sustained high volumes across core codes indicate a long‑standing, large Medicaid‑focused FQHC serving substantial patient volumes in its community.

Medicaid: Complete Services Breakdown

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

206 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	890,610	$30	$29.4M
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…	138,620	$40	$5.7M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	378,940	$10	$4.9M
T2023	Targeted case management; per month	9,470	$320	$3M
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	64,280	$40	$2.6M
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,…	83,920	$30	$2.1M
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…	30,190	$60	$1.9M
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…	33,480	$60	$1.8M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	28,390	$60	$1.7M
90834	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…	26,250	$50	$1.4M

Showing 1–10 of 206

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

Cumberland Family Medical Center Inc — 23 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

206 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2023	Targeted case management; per month	45	530	530	$300	$1.1M
90887	In this service, the provider interprets or explains the results of psychiatric exams, medical exams, other procedures, or information about the patient’s care to the patient’s family members or…	21	140	460	$70	$475.2K
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…	90	1,270	760	$80	$447.2K
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	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…	99	2,460	580	$40	$245K
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…	4	600	600	$40	$207.8K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	74	90	250	$90	$199.4K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	315	470	770	$20	$188.2K
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…	2	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…	78	80	480	$50	$177.8K

Showing 1–10 of 206

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jacob Burton	KY	Optometrist	$40.9K	$721K
Sarai Williams	KY	Optometrist	$29K	$496.5K
Shannah Click	KY	Family Nurse Practitioner	$82.7K	$0
Savannah Nally	KY	Family Nurse Practitioner	$47.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cumberland County Hospital Association Inc	KY	Critical Access Hospital	$0	$8.6M
Adult Day Health, Inc.	KY	Adult Day Care Clinic/Center	$0	$4.3M
Cumberland County Hospital Association Inc	KY	Land Ambulance	$219.4K	$183.2K

Cumberland Family 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