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NPI 1316925506 · South Charleston, WV · General Acute Care Hospital
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Herbert J. Thomas Memorial Hospital Association is a general acute care hospital provider located in South Charleston, West Virginia. This profile covers 0 Medicare and 353 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Herbert J. Thomas Memorial Hospital Association |
| Address | 4605 Maccorkle Ave Sw |
| City | South Charleston |
| State | WV |
| ZIP | 25309 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | January 6, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $26.1M |
| Medicare | $0 |
This provider is effectively single‑payer in the Medicare/Medicaid mix: Total Medicare revenue is listed as none (no Medicare billing on file) while Total Medicaid revenue is $26.1M, indicating the hospital’s reported revenue footprint in these datasets is driven entirely by Medicaid. That concentration makes Medicaid utilization patterns the primary signal for payer contracting and network decisions.
Revenue is highly concentrated in emergency department E/M codes: the precomputed top‑3 Medicaid codes account for 39.8% of this provider’s total Medicaid revenue, with 99284 reported at $2.9M (18.3%), 99285 at $1.8M (11.4%), and 99283 at $1.6M (10.2%). This concentration signals that ED visits are the single largest revenue driver within Medicaid for the hospital.
The overall code mix points to an acute care, ED‑centric hospital with on‑site observation and procedural capacity: high revenue and claim counts for ED E/M codes (99284/99285/99283), observation per hour G0378 ($1.1M, 6.9%), substantial IV infusion administration codes (96365, 96374, 96375 each contributing multiple hundreds of thousands in revenue), and advanced imaging and endoscopy like 74177 ($703.9K) and 43239 ($362.6K). Together these suggest the facility operates as a typical community acute hospital that manages ED throughput, observation stays, and associated diagnostics and procedures.
Competitive standing for the ED codes is mixed but generally within upper state percentiles: 99284 is #21 of 168 providers in‑state (88th percentile; typical, unremarkable volume), 99285 is #34 of 132 (75th percentile; typical, unremarkable volume), and 99283 is #19 of 163 (89th percentile; typical, unremarkable volume). In plain terms, the hospital reports solid ED volumes relative to many peers without appearing dominant statewide for these services.
Laboratory and specimen‑related activity is an identifiable strength and includes statistical outliers: 36415 shows 66.7K claims and $867K revenue and ranks #4 of 328 providers in‑state (99th percentile; extreme outlier), while 83880 is reported at $248.4K and ranks #1 of 51 providers in‑state (100th percentile; extreme outlier). High volumes and rankings for routine lab panels (85025, 80053, 80047/80048, 80076) further indicate substantial in‑house lab throughput that likely supports ED and inpatient workflows.
Observation and short‑term care services appear material to operations: G0378 has 7K claims, $160 avg paid/claim, and $1.1M revenue (6.9%) and ranks #5 of 45 providers in‑state (91st percentile; typical, unremarkable volume). The combination of observation hours, high‑acuity ED codes (99285), and frequent IV administration codes implies the hospital manages a meaningful volume of patients who require extended ED care or observation rather than immediate inpatient admission.
The provider has an established presence in the region with a long enumeration history: NPI enumerated 2006‑01‑06 (~20 years ago). That tenure, combined with $26.1M in Medicaid revenue and the described service mix, supports the view of a stable community acute care hospital with concentrated Medicaid activity and notable lab/ED throughput strengths.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
353 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. | 21,780 | $140 | $2.9M |
| 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. | 6,250 | $290 | $1.8M |
| 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. | 20,240 | $80 | $1.6M |
| G0378 | Hospital observation service, per hour | 6,980 | $160 | $1.1M |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 6,310 | $150 | $952.2K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 66,690 | $10 | $867K |
| 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… | 61,030 | $10 | $854.4K |
| 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. | 5,030 | $140 | $703.9K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 6,130 | $80 | $460.1K |
| 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. | 35,180 | $10 | $422.1K |
Showing 1–10 of 353
How this provider's Medicaid billing volume and revenue compare to other West Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. West Virginia median
353 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 34 | 130 | 2,090 | $210 | $1.5M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 12 | 20 | 270 | $20 | $1.5M |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 10 | 10 | 580 | $1,120 | $1.3M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 22 | 40 | 820 | $30 | $1.2M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 22 | 40 | 820 | $30 | $1.2M |
| 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. | 21 | 170 | 3,350 | $120 | $1.1M |
| 88175 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 9 | 20 | 70 | $20 | $832.7K |
| 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… | 15 | 30 | 180 | $40 | $773.3K |
| 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. | 19 | 160 | 3,690 | $80 | $714.8K |
| 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. | 17 | 80 | 950 | $140 | $559.5K |
Showing 1–10 of 353
Other providers in the same ZIP code as Herbert J. Thomas Memorial Hospital Association, ranked by combined Medicare and Medicaid revenue.
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