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

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

The Children's Mercy Hospital (NPI 1366515488)

Field	Value
Entity Type	Organization
Organization	The Children's Mercy Hospital
Address	2401 Gillham Rd
City	Kansas City
State	MO
ZIP	64108
Taxonomy	Children's Hospital
NPI Enumerated	November 16, 2006

Payer Source	Total Paid
Medicaid	$221M
Medicare	$0

Key Findings

THE CHILDREN'S MERCY HOSPITAL is effectively single‑payer in this dataset: there is no Medicare billing on file and the provider reports $221M in total Medicaid revenue. This means Medicaid dominates its publicly visible payer mix and any analysis of scale or utilization should be framed around Medicaid activity rather than Medicare comparisons.

Revenue is highly concentrated in a small set of outpatient/service codes: the precomputed top 3 Medicaid codes account for 50.9% of total Medicaid revenue. Those top three are G0463 ($44.6M, 23.0%), X4011 ($29.7M, 15.3%), and X4003 ($24.3M, 12.5%), indicating that a handful of service lines generate the majority of billed Medicaid dollars.

The presence of G0463 (Hospital outpatient clinic visit) as the single largest revenue line ($44.6M, 23.0%) alongside high-volume emergency visit codes (99283 $20.1M, 10.4%; 99284 $7.3M, 3.8%; 99282 $2.6M, 1.3%) suggests a combined model of substantial outpatient clinic throughput plus a busy emergency department. This mix is consistent with a pediatric tertiary or regional children’s hospital that handles both scheduled outpatient management and high ED volume.

Competitive standing in-state is strong on multiple high-revenue codes: G0463 ranks #3 of 96 providers in-state (98th percentile; extreme outlier), X4003 ranks #2 of 69 (99th percentile; extreme outlier), and X4011 ranks #6 of 106 (95th percentile; notably above typical state volume). These rank/percentile positions characterize the provider as a dominant or major statewide participant for those specific services rather than a modest local provider.

Laboratory and infectious-disease testing volumes are also elevated and concentrated: 87400 ($4.4M, 2.3%), 87430 ($4.0M, 2.1%), and U0003 (45K claims, $1.3M, 0.7%) all rank at the top of in-state lists (87400 and 87430 rank #1 of their peer groups; U0003 ranks #1 of 83). This pattern points to significant on-site diagnostics capacity and high throughput for viral/respiratory testing and point-of-care lab services.

While major revenue comes from outpatient clinic and ED codes, the provider also reports meaningful imaging and procedure revenue streams—93325 ($3.0M, 1.5%) ranks #4 of 70 and 70551 ($1.1M, 0.6%) ranks #4 of 67—indicating in-house cardiology imaging and MRI capability. These ancillary service lines diversify revenue beyond the top three codes and support a full-service pediatric hospital profile.

Several high-volume codes appear as statistical outliers statewide (labels per the source include "extreme outlier" or "notably above typical"); for example, 99283 is an "extreme outlier" at the 100th percentile (#5 of 1263) and X4003 is an "extreme outlier" at the 99th percentile (#2 of 69). For payers and network analysts, these outlier statuses suggest referral concentration and service specialization that may require targeted rate-setting or utilization-management review for those specific codes.

THE CHILDREN'S MERCY HOSPITAL has an established presence based on enumeration date: NPI enumerated 2006-11-16 (~20 years ago). This tenure combined with concentrated, high-percentile Medicaid volumes supports interpreting the facility as a long-standing, high-capacity pediatric provider within Missouri’s Medicaid system.

Medicaid: Complete Services Breakdown

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

264 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	268,470	$170	$44.6M
X4011	N/A	32,890	$900	$29.7M
X4003	N/A	154,520	$160	$24.3M
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.	65,810	$310	$20.1M
X4014	N/A	13,060	$1,370	$17.9M
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.	18,730	$390	$7.3M
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…	99,590	$50	$4.6M
87400	The lab analyst performs the technical lab test to detect antigens of influenza A or B using an immunoassay technique, such as EIA. This analysis will distinguish if a patient has influenza A or B.	5,920	$740	$4.4M
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	11,530	$350	$4.1M
87430	The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.	7,070	$560	$4M

Showing 1–10 of 264

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

The Children's Mercy Hospital — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

264 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
X4011	N/A	6	110	5,700	$340	$3.2M
X4014	N/A	1	10	1,070	$1,030	$2.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	3	100	2,240	$80	$2.2M
Y7506	N/A	80	100	980	$250	$1.6M
X4003	N/A	2	70	1,480	$80	$1.1M
X4006	N/A	30	50	370	$780	$969.5K
Y7507	N/A	41	50	270	$360	$594.9K
83498	The lab analyst measures the 17 hydroxyprogesterone in a sample such as blood, serum, urine, or even amniotic fluid. This hormone is a building block for the adrenal cortex hormone cortisol.	3	10	40	$20	$484.2K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	76	90	1,850	$120	$384.1K
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.	67	600	140	$170	$384.1K

Showing 1–10 of 264

Related Providers

Other providers that share a Tax Identification Number (TIN) with The Children's Mercy Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Children's Mercy Hospital	MO	Pediatrics Physician	$0	$53.6M
The Children's Mercy Hospital	MO	Durable Medical Equipment & Medical Supplies	$0	$28.3M
The Children's Mercy Hospital	KS	Children's Hospital	$0	$22.3M
The Children's Mercy Hospital	MO	Ambulance	$0	$13.4M
Children's Mercy-community Choice Pediatrics	MO	Pediatrics Physician	$0	$9M
David Dyer	KS	Ophthalmology Physician	$7.5M	$0
Children's Mercy-cockerell And Mcintosh Pediatrics, Inc	MO	Pediatrics Physician	$0	$6.3M
University Of Kansas Hospital Authority	KS	Multi-Specialty Clinic/Center	$0	$3.9M
Abraham Poulose	KS	Retina Specialist (Ophthalmology) Physician	$1.8M	$0
Atul Patel	KS	Physical Medicine & Rehabilitation Physician	$932.1K	$0

Nearby Providers

Other providers in the same ZIP code as The Children's Mercy Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Truman Medical Center, Incorporated	MO	General Acute Care Hospital	$0	$233.8M
University Health Physicians	MO	Internal Medicine Physician	$0	$102.8M
Truman Medical Center, Incorporated	MO	Community/Behavioral Health Agency	$0	$37.8M
Bethel Home Healthcare LLC	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$24.3M
Truman Medical Center, Incorporated	MO	Otolaryngology Physician	$0	$14.1M
Help At Home, LLC	MO	Nursing Care Agency	$0	$5.2M
Truman Medical Center Incorporated	MO	Body Imaging Physician	$0	$4.6M
Truman Medical Center Incorporated	MO	Community/Behavioral Health Agency	$0	$4.6M
Aspire Home Health Inc	MO	Home Health Agency	$0	$4.5M
Jordan Smith	MO	Diagnostic Radiology Physician	$316.6K	$0

The Children's Mercy Hospital — Billing Profile & Reimbursement Data

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The Children's Mercy Hospital — 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