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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Duke University Health System, Inc. (NPI 1376574798)

Duke University Health System, Inc. is a internal medicine physician provider located in Durham, North Carolina. This profile covers 0 Medicare and 32 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	Duke University Health System, Inc.
Address	3643 N Roxboro St
City	Durham
State	NC
ZIP	27704
Taxonomy	Internal Medicine Physician
NPI Enumerated	July 5, 2006

Payer Source	Total Paid
Medicaid	$7.6M
Medicare	$0

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

32 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	35,720	$80	$2.7M
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.	34,570	$70	$2.5M
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…	24,850	$40	$1.1M
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…	17,350	$30	$589.7K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	3,240	$80	$262.8K
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…	4,490	$40	$197.4K
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.	2,590	$40	$106K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	1,230	$50	$57.9K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	860	$50	$42.9K
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…	840	$30	$20.9K

Showing 1–10 of 32

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Duke University Health System, Inc. — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

32 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.	51	330	6,130	$130	$2.7M
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.	190	320	6,160	$120	$2.1M
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.	24	280	2,690	$130	$1.6M
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.	110	150	1,340	$80	$395.9K
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	2,413	2,850	10,910	$10	$330.3K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	1,237	1,710	810	$80	$274.5K
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…	963	4,400	960	$60	$271.3K
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…	1,897	4,130	670	$50	$219.9K
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…	12	340	260	$60	$187.4K
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…	36	510	480	$40	$166.3K

Showing 1–10 of 32

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Private Diagnostic Clinic, PLLC	NC	General Practice Physician	$0	$46.5M
Duke University Health System, Inc.	NC	General Acute Care Hospital	$0	$44.4M
Duke Health Integrated Practice, Inc.	NC	General Practice Physician	$0	$36.3M
Duke University Health System, Inc.	NC	General Acute Care Hospital	$0	$11.6M
Duke University Affiliated Physicians, Inc.	NC	Emergency Medicine Physician	$0	$11.6M
Duke University Health System, Inc.	NC	Parenteral & Enteral Nutrition Supplies (DME)	$0	$8.3M
Duke University Health System Inc	NC	General Acute Care Hospital	$0	$7.9M
Majda Hadziahmetovic	NC	Ophthalmology Physician	$2.3M	$0
Michael Allingham	NC	Retina Specialist (Ophthalmology) Physician	$1.7M	$0
Associated Health Services, Inc.	NC	Ambulatory Surgical Clinic/Center	$1.6M	$102.4K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Emergeortho PA	NC	Orthopaedic Surgery Physician	$0	$20.9M
Private Diagnostic Clinic, PLLC	NC	Pediatrics Physician	$0	$17.5M
Sunrise Clinical Associates, PLLC	NC	Community/Behavioral Health Agency	$0	$16.5M
County Of Durham Finance Dept	NC	Land Ambulance	$2.4M	$11.3M
Rapha Healthcare Services,llc	NC	Multi-Specialty Clinic/Center	$0	$13.6M
Php Of Nc, Inc	NC	Developmentally Disabled Services Day Training Agency	$0	$12.7M
Bayada Home Health, Care, Inc.	NC	Home Health Agency	$0	$11.6M
John Dellabadia	NC	Neurology Physician	$232.2K	$808.8K
Durham Diagnostic Imaging LLC	NC	Diagnostic Radiology Physician	$559.7K	$0
David Sappenfield	NC	Retina Specialist (Ophthalmology) Physician	$512.7K	$0

Duke University Health System, Inc. — 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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