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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Pocahontas Memorial Hospital (NPI 1346523206)

Pocahontas Memorial Hospital is a rural health clinic/center provider located in Buckeye, West Virginia. This profile covers 0 Medicare and 11 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Pocahontas Memorial Hospital
Address	150 Duncan Rd
City	Buckeye
State	WV
ZIP	24924
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	September 27, 2011

Payer Source	Total Paid
Medicaid	$3.1M
Medicare	$0

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

11 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	20,970	$140	$2.9M
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…	8,600	$20	$172.1K
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…	5,420	$10	$48.8K
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,…	210	$10	$1.7K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	10	$100	$1.3K
99429	Use 99429 to report a preventive medicine service that does not have a specific code.	20	$10	$210
99304	The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves straightforward or low medical decision making or the provider…	20	$10	$190
99305	The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least…	20	$0	$0
99307	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making or the…	50	$0	$0
99308	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider…	190	$0	$0

Showing 1–10 of 11

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Pocahontas Memorial Hospital — 0 of 7 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

11 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	96	390	4,610	$130	$2.2M
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…	242	1,270	1,240	$30	$245K
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…	171	1,030	890	$50	$221K
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,…	306	540	320	$20	$43.2K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	15	80	310	$10	$37.1K
99308	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider…	59	90	370	$10	$15.9K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	177	200	80	$30	$13.4K
99307	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making or the…	52	60	280	$10	$3.7K
99304	The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves straightforward or low medical decision making or the provider…	10	20	50	$10	$2.1K
99305	The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least…	21	30	40	$30	$1.9K

Showing 1–10 of 11

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pocahontas Memorial Hospital	WV	Critical Access Hospital	$0	$3.6M
Pocahontas Memorial Hospital	WV	Ambulance	$133.8K	$270.1K
Randolph Modlin	WV	Cardiovascular Disease Physician	$184.7K	$0
Michael Johnson	WV	Family Medicine Physician	$155.9K	$0
Ahmad Ramy Elashery	FL	Cardiovascular Disease Physician	$106.2K	$0
Tommy Holbrook	WV	Family Medicine Physician	$60.2K	$0

Pocahontas Memorial Hospital — Billing Profile & Reimbursement Data

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Pocahontas Memorial Hospital — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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