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 Nebraska for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Nebraska 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. Nebraska (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.

Children's Hospital & Medical Center (NPI 1346297843)

Key Findings

Field	Value
Entity Type	Organization
Organization	Children's Hospital & Medical Center
Address	8200 Dodge St
City	Omaha
State	NE
ZIP	68114
Taxonomy	Children's Hospital
NPI Enumerated	May 28, 2006

Payer Source	Total Paid
Medicaid	$89.8M
Medicare	$0

CHILDREN'S HOSPITAL & MEDICAL CENTER is effectively a Medicaid-focused provider with no Medicare billing on file and $89.8M in total Medicaid revenue, indicating its commercial footprint in Medicare is absent for the period covered. The absence of Medicare revenue makes this profile single-payer in practice, so Medicaid reimbursement dynamics will largely determine its financial and operational positioning in the state.

Revenue is concentrated: the top three Medicaid CPT/HCPCS codes by revenue account for 34.3% of the provider's total Medicaid revenue, which signals that a relatively small set of services—predominantly emergency and procedural care—drive a disproportionate share of its Medicaid receipts. This concentration suggests operational emphasis and potential revenue vulnerability if payer policies or demand change for those service lines.

Emergency department E/M codes are primary revenue drivers. Codes 99283 ($9.2M; 15.7% of Medicaid revenue) and 99284 ($7.1M; 12.1% of Medicaid revenue) together represent a large share of revenue and high-volume ED utilization, consistent with a busy pediatric emergency service line. Both codes rank highly statewide (99283 at the 97th percentile and 99284 at the 94th percentile), positioning the hospital as a major pediatric ED provider relative to in-state peers.

Several high-acuity diagnostic and procedure codes further define the service mix: 93306 and 93303 (echocardiography codes) and 43239 (EGD with biopsy) appear among top Medicaid billings, indicating an in-house capability for pediatric cardiology imaging and GI endoscopy. The presence of 41899 (dentoalveolar procedures), 69436 (tympanostomy with tube), and 70553 (brain MRI) also point to broad pediatric surgical and imaging services that support comprehensive inpatient and outpatient specialty care.

The hospital is a clear statewide leader or outlier on specific pediatric services: it ranks #5 of 139 providers for 99283 (97th percentile, described as an extreme outlier) and #2 of 92 providers for 99282 (99th percentile, also an extreme outlier), demonstrating exceptionally high ED claim volumes relative to peers. Other codes show notable above-typical volume or top percentile rankings—87633 (100th percentile, #1 of 20) and 92587 (#1 of 5, 100th percentile)—which reinforces the facility’s dominant role in certain pediatric diagnostics and screening services.

Operational throughput is high across both routine therapy and intensive services: 97530 (therapeutic activities) has 13K claims contributing $2M, and 96361 (IV fluids, additional hour) has 4.7K claims contributing $2.2M, reflecting sustained therapy, infusion, and observation activity beyond episodic ED visits. G0378 (hospital observation per hour) at 6.4K claims and 94640 (airway management/oxygen) at 9.4K claims further indicate frequent short-stay and respiratory interventions typical in pediatric acute care settings.

This provider has long tenure in the NPI registry, enumerated since 2006-05-28 (~20 years ago), which supports a well-established presence in the market and likely built clinical infrastructure to support the high volumes observed across emergency, diagnostic, and specialty pediatric services. The longevity combined with the code mix suggests institutional capacity for complex pediatric care and sustained relationships with Medicaid populations.

While many high-volume codes are typical for a comprehensive children’s hospital, concentration in a handful of codes (top three = 34.3%) and repeated extreme-outlier rankings for ED and certain diagnostic codes imply strategic strengths and potential risks: strengths in market dominance for pediatric emergency and specialized testing, and risk that reimbursement or utilization shifts for these few high-revenue services could materially affect overall Medicaid revenue.

Medicaid: Complete Services Breakdown

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

417 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	42,370	$220	$9.2M
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.	28,950	$250	$7.1M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	1,470	$2,560	$3.8M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	4,130	$820	$3.4M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	4,350	$730	$3.2M
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	1,770	$1,490	$2.7M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	1,190	$2,190	$2.6M
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	2,520	$970	$2.4M
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.	4,700	$480	$2.2M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	13,000	$150	$2M

Showing 1–10 of 417

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Nebraska providers billing the same CPT/HCPCS codes.

Claims Volume vs. Nebraska Distribution

Children's Hospital & Medical Center — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

417 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	5	20	460	$1,260	$1.8M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	2	10	4,350	$250	$1.5M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	4	30	990	$180	$864.6K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	1	10	730	$1,150	$838.5K
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.	8	110	770	$110	$774.3K
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.	6	40	820	$260	$734.1K
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.	5	140	1,100	$110	$607.4K
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	80	300	$120	$519.5K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	3	20	240	$900	$448.5K
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	2	10	240	$1,540	$424.6K

Showing 1–10 of 417

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Physicians	NE	Pediatrics Physician	$0	$39.4M
Physicians Clinic Inc	NE	Family Medicine Physician	$0	$20.5M
Nebraska Methodist Hospital	NE	General Acute Care Hospital	$0	$14.5M
Smiles 4 Kids PC	NE	General Practice Dentistry	$0	$11.5M
Nebraska Methodist Hospital	NE	Emergency Medicine Physician	$0	$5.3M
Unmc College Of Dentistry	NE	Dentist	$0	$4.8M
Stones Worth Stepping, P.C.	NE	Occupational Therapist	$0	$4.7M
Pacific Surgery Center, LLC	NE	Ambulatory Surgical Clinic/Center	$3.4M	$3.2K
Stefano Tarantolo	NE	Hematology & Oncology Physician	$3.2M	$0
Midwest Endoscopy Services LLC	NE	Ambulatory Surgical Clinic/Center	$1.9M	$874.4K

Children's Hospital & Medical Center — 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
Nebraska Pediatric Practice, Inc	NE	Pediatrics Physician	$0	$29M
Children's Hospital & Medical Center	NE	Multi-Specialty Clinic/Center	$0	$10M
Children's Hospital	NE	Pediatric Emergency Medicine (Pediatrics) Physician	$0	$8.4M
Children's Specialty Physician Billing - Behavioral Health	NE	Psychologist	$0	$1.9M
Children's Rehab - Occupational Therapy	NE	Pediatric Occupational Therapist	$0	$388.1K