Mercy Health-lourdes Hospital LLC — Billing Profile & Reimbursement Data
NPI 1346244126 · Paducah, KY · General Acute Care Hospital
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Mercy Health-lourdes Hospital LLC is a general acute care hospital provider located in Paducah, Kentucky. This profile covers 0 Medicare and 444 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 | Mercy Health-lourdes Hospital LLC |
| Address | 1530 Lone Oak Rd |
| City | Paducah |
| State | KY |
| ZIP | 42003 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | June 9, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $61.9M |
| Medicare | $0 |
Key Findings
This provider is effectively single‑payer in the available data: there is no Medicare billing on file while total Medicaid revenue is $61.9M. The NPI was enumerated on 2005-06-09 (~21 years ago), indicating an established acute‑care hospital presence in Paducah, KY that is operating primarily in the Medicaid market rather than Medicare.
Revenue is highly concentrated in emergency department evaluation and management: the top three Medicaid codes are 99284 ($6.3M, 15.2%), 99285 ($6M, 14.3%), and 99283 ($5M, 12.0%), which together account for 41.6% of the provider’s Medicaid revenue. This concentration signals that ED visits are the primary revenue driver for the hospital and should be the focus of any utilization or contract review.
Volume details reinforce an ED‑centric operational profile: the top ED codes show high claim counts (99283: 27.7K claims; 99284: 25.2K claims; 99285: 17.6K claims) and substantial per‑claim payments, consistent with a busy emergency department handling a broad acuity mix. The mix of low, moderate, and high E/M levels suggests both high throughput and a significant share of higher‑acuity presentations.
Competitive standing for ED services is broadly typical within Kentucky: 99284 ranks #52 of 282 providers in‑state (82th percentile), 99285 ranks #46 of 239 providers (81th percentile), and 99283 ranks #49 of 284 providers (83th percentile). These rankings indicate the hospital is a solid, routine participant in state ED volumes rather than a statewide dominant outlier for those codes.
Beyond E/M, the provider shows large volumes in medication administration, infusion, and supportive procedures that align with ED and inpatient throughput: 96374 ($2.2M, 48.9K claims; ranks #7 of 107 providers, 94th percentile), 96375 ($1.3M, 22.8K claims), 96365 ($1.1M, 17.8K claims), and 96366 ($691.8K, 6.4K claims). These patterns point to extensive IV drug administration and short infusions as a meaningful operational line, supporting both acute care and procedural services.
Laboratory and basic access services are notable volume drivers and statistical outliers for the state: PLA test 0202U accounts for $2.9M (6.9%) and ranks #4 of 27 providers in‑state (88th percentile) for that specific proprietary respiratory panel, while routine venipuncture 36415 produced 181.7K claims and $545.1K revenue and is an "extreme outlier, far above typical state volume" (99th percentile). High throughput of basic lab collection plus targeted PLA testing suggests the hospital processes a large number of ED/outpatient specimens and uses cartridge/automated respiratory diagnostics at scale.
Wound care and selected procedures show above‑typical intensity: 97597 is $731.4K (1.8%) and ranks #4 of 62 providers (95th percentile), labeled "notably above typical state volume." Coupled with high counts of injections (96372: $517.8K, 27.3K claims; "extreme outlier" 99th percentile), this indicates robust outpatient wound and injection services—important ancillary lines that add materially to Medicaid revenue.
Imaging and advanced diagnostics are sizable complements to the ED/inpatient mix: 74177 ($2.7M, 6.4%), 70450 ($1.4M, 3.3%), 70553 ($798.8K, 1.9%), and SPECT 78452 ($832.9K, 2.0%) together reflect significant CT/MRI/nuclear imaging capacity tied to acute evaluation. For payers and network planners, these imaging volumes support the picture of a full‑service acute hospital handling complex diagnostic workups alongside high ED throughput.
Medicaid: Total Revenue Breakdown by CPT/HCPCS Code
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
Medicaid: Complete Services Breakdown
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
444 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. | 25,230 | $250 | $6.3M |
| 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. | 17,620 | $340 | $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. | 27,710 | $180 | $5M |
| 0202U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the… | 9,070 | $320 | $2.9M |
| 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. | 8,520 | $310 | $2.7M |
| 96374 | The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition. | 48,890 | $40 | $2.2M |
| 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. | 9,070 | $150 | $1.4M |
| 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… | 6,090 | $220 | $1.3M |
| 96375 | Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the… | 22,790 | $60 | $1.3M |
| 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. | 11,500 | $110 | $1.3M |
Showing 1–10 of 444
Medicaid: Competitive Analysis & Benchmarks
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
444 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. | 52 | 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. | 46 | 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. | 49 | 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. | 39 | 180 | 1,870 | $280 | $1.5M |
| G0378 | Hospital observation service, per hour | 13 | 90 | 2,770 | $190 | $1.3M |
| 0202U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the… | 4 | 30 | 2,320 | $290 | $1.2M |
| C1776 | Joint device (implantable) | 18 | 20 | 130 | $2,890 | $1.1M |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 24 | 80 | 7,740 | $30 | $1.1M |
| C1713 | Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) | 23 | 40 | 550 | $910 | $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. | 91 | 170 | 2,610 | $250 | $1M |
Showing 1–10 of 444
Nearby Providers
Other providers in the same ZIP code as Mercy Health-lourdes Hospital LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Baptist Healthcare System, Inc | KY | General Acute Care Hospital | $0 | $72.6M |
| Baptist Health Medical Group Inc | KY | Family Medicine Physician | $0 | $21.9M |
| Mercy Health Physicians Kentucky LLC | KY | Family Medicine Physician | $0 | $11.9M |
| Ambulatory Surgery Center LLC | KY | Ambulatory Surgical Clinic/Center | $771.4K | $8.7M |
| Joseph Blackmon | KY | MOHS-Micrographic Surgery Physician | $6.9M | $0 |
| John Colgan Jr. | KY | Pediatric Dentistry | $0 | $5.6M |
| Mercy Health Physicians Kentucky Specialty Care LLC | KY | Surgery Physician | $0 | $4.7M |
| Justin Colgan | KY | Pediatric Dentistry | $0 | $4.6M |
| Paducah Ophthalmology Asc LLC | KY | Ambulatory Surgical Clinic/Center | $1.3M | $467.8K |
| Halden Ford | KY | Dermatology Physician | $1.3M | $4.5K |
Frequently Asked Questions
References
- 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
- 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.
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