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.

Kentucky Medical Services Foundation, Inc (NPI 1326091448)

Key Findings

Field	Value
Entity Type	Organization
Organization	Kentucky Medical Services Foundation, Inc
Address	2333 Alumni Park Plz
City	Lexington
State	KY
ZIP	40517
Taxonomy	Internal Medicine Physician
NPI Enumerated	May 18, 2006

Payer Source	Total Paid
Medicaid	$110.4M
Medicare	$0

This provider is effectively single-payer in scope: there is no Medicare billing on file and the practice shows $110.4M in lifetime Medicaid revenue, signaling heavy dependence on Medicaid for its billed volume and financial footprint. The absence of Medicare activity may simplify payer mix analysis but also indicates limited exposure to or participation in Medicare programs.

Revenue is concentrated in a small set of Medicaid codes: the top three Medicaid codes (99469, 99214, 99285) together account for 30.5% of the provider's total Medicaid revenue, with those individual line items reported as $9.2M (99469, 11.1%), $8.7M (99214, 10.4%), and $7.4M (99285, 9.0%). This concentration means a few service lines materially drive the provider’s Medicaid receipts and will shape contract negotiations and utilization management focus.

Clinical mix points to a hospital-based system with strong neonatal and pediatric critical care capacity: high-revenue neonatal critical-care codes appear prominently (99469 $9.2M, 99472 $5.9M, 99480 $2.1M), indicating substantial newborn/infant inpatient critical-care activity in addition to outpatient and follow-up neonatal services. The presence of these codes suggests an operational focus that includes NICU-level services and care coordination for critically ill infants.

The provider also demonstrates very high emergency and inpatient E/M volumes consistent with an integrated acute care operation: 99285 ($7.4M, 83.6K claims), 99284 ($6.9M, 112K claims), 99283 ($4.7M, 111K claims) and subsequent inpatient care codes 99232 ($6.7M, 230.4K claims) and 99233 ($3.6M, 93.6K claims) point to a busy emergency department and high inpatient throughput. These high-claim counts and mid-to-high acuity E/M codes are consistent with large-scale ED and hospitalist services rather than a small outpatient clinic.

Imaging, diagnostics, and procedure capacity are significant revenue components and further support a hospital or multispecialty network footprint: notable lines include CT abdomen/pelvis 74177 ($2.7M), MRI brain 70553 ($1.5M), CT head 70450 ($991.2K), CTA chest 71275 ($784.7K), chest x-ray 71045 ($1.4M), echocardiography 93306 ($1.8M) and tympanostomy 69436 ($783.5K). Many of these services rank at or near the top in-state (for example 70553 and 71045 each rank #1 in-state at the 100th percentile), showing the provider is processing very high imaging and procedure volumes relative to Medicaid peers.

On competitive standing, the provider is a dominant Medicaid participant for multiple high-revenue services: several codes are in the 100th percentile statewide (for example 99469 #1 of 10, 99472 #1 of 7, 99232 #2 of 474 but 100th percentile, 71045 #1 of 228), and many additional codes are described as "extreme outlier" or "notably above typical state volume." This pattern indicates market-leading share for several service lines within Kentucky Medicaid, which may translate to negotiating leverage with managed Medicaid plans and regional referral influence.

Multiple codes are explicitly labeled as statistical outliers in-state, including both office/ED E/M codes (99214 described as an "extreme outlier, far above typical state volume" at the 99th percentile) and inpatient/subsequent care codes (99232 and 99233 marked as 100th and 99th percentile respectively). These outlier designations suggest the provider’s volumes are unusually concentrated compared with in-state peers, which is operationally notable for capacity planning, utilization review, and payer audits without implying misconduct.

The NPI has long tenure: enumerated on 2006-05-18 (~20 years ago), indicating an established operation with multi-year claims history in Medicaid. Combined with the concentrated Medicaid revenue base and dominant code-level rankings, this tenure supports the interpretation of a stable, mature Medicaid-focused provider whose contracting strategies and operational scale are driven by hospital-level neonatal, emergency, inpatient, imaging, and procedure services.

Medicaid: Complete Services Breakdown

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

416 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	35,740	$260	$9.2M
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…	180,710	$50	$8.7M
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.	83,560	$90	$7.4M
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.	111,960	$60	$6.9M
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…	230,420	$30	$6.7M
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…	179,670	$40	$6.3M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	23,160	$250	$5.9M
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.	111,040	$40	$4.7M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	93,570	$40	$3.6M
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.	47,080	$60	$2.7M

Showing 1–10 of 416

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

Kentucky Medical Services Foundation, Inc — 25 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

416 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.	6	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.	5	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.	6	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.	3	180	1,870	$280	$1.5M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	1	10	600	$260	$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.	31	170	2,610	$250	$1M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	1	10	120	$250	$878.8K
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.	3	180	2,960	$110	$672.4K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	21	160	2,900	$110	$610.8K
72197	In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the pelvis first without using contrast and again after injecting contrast material.	4	10	880	$680	$572.9K

Showing 1–10 of 416

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Of Kentucky	KY	General Acute Care Hospital	$0	$716.8M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Union Associated Physicians Clinic, LLC	IN	Family Medicine Physician	$0	$31.1M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Kentucky Medical Services Foundation	KY	Nurse Practitioner	$0	$12.5M
Kyle Thompson	ID	Retina Specialist (Ophthalmology) Physician	$4.5M	$0
University Of Kentucky	KY	Dentist	$0	$4.3M
Kentucky Medical Services Foundation	KY	Physician Assistant	$0	$3.4M
Matthew Cole	TN	Ophthalmology Physician	$3.3M	$0
Kentucky Medical Services Foundation	KY	Pediatrics Physician	$0	$3.3M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bluegrass Area Development District	KY	Case Management Agency	$0	$75.4M
Bluegrass Area Development District	KY	Supports Brokerage Agency	$0	$65.3M
Afton Communiy Day, Inc.	KY	Adult Day Care Clinic/Center	$0	$56M
Baptist Health Medical Group Inc	KY	Nurse Practitioner	$0	$54.1M
Families Hope, LLC	KY	Adult Care Home Facility	$0	$19.4M
Central Kentucky Radiology PLLC	KY	Diagnostic Radiology Physician	$0	$17.6M
Lionheart Trauma Support Services, LLC	KY	Clinical Social Worker	$0	$3.5M
Johannes Evans	KY	Ophthalmology Physician	$291.9K	$588.5K
David Blandford	KY	Ophthalmology Physician	$260.1K	$58.1K
William Curtis	KY	Ophthalmology Physician	$216.2K	$84.2K

Kentucky Medical Services Foundation, Inc — Billing Profile & Reimbursement Data

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Kentucky Medical Services Foundation, 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