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

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

Kentucky Pain Management Services (NPI 1376692657)

Kentucky Pain Management Services is a pain clinic/center provider located in Hazard, Kentucky. This profile covers 0 Medicare and 28 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	Kentucky Pain Management Services
Address	311 Roy Campbell Drive
City	Hazard
State	KY
ZIP	41701
Taxonomy	Pain Clinic/Center
NPI Enumerated	January 9, 2007

Payer Source	Total Paid
Medicaid	$3.5M
Medicare	$0

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	67,890	$30	$1.9M
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,…	24,530	$20	$441.6K
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…	30,280	$10	$393.6K
27096	The provider performs an injection in the joint between the sacrum and ilium on one side of the body, with the aid of imaging equipment to locate the injection site. He injects an anesthetic to…	1,160	$240	$278.8K
G0481	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	2,870	$50	$140.5K
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	2,470	$50	$120.9K
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…	5,220	$10	$73.1K
72131	In this diagnostic procedure, the provider performs a computed tomography, or CT, examination of the lumbar spine without using contrast material.	1,030	$40	$37K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	360	$80	$30.6K
64493	The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance…	100	$90	$8.6K

Showing 1–10 of 28

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Kentucky Pain Management Services — 2 of 22 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	30	70	1,650	$100	$2M
G0481	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	26	80	990	$60	$912.2K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	19	340	2,700	$40	$673.3K
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…	215	3,340	1,020	$30	$296K
72125	In this diagnostic procedure, the provider performs a computed tomography, or CT, examination of the cervical spine without contrast material.	88	130	820	$160	$258.5K
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…	392	2,460	580	$40	$245K
62323	The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)…	60	80	260	$190	$182.3K
72131	In this diagnostic procedure, the provider performs a computed tomography, or CT, examination of the lumbar spine without using contrast material.	24	90	350	$180	$175.8K
27096	The provider performs an injection in the joint between the sacrum and ilium on one side of the body, with the aid of imaging equipment to locate the injection site. He injects an anesthetic to…	4	30	120	$200	$154.3K
J3490	Unclassified drugs	74	100	780	$20	$146.6K

Showing 1–10 of 28

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Robetta Baker	KY	Family Nurse Practitioner	$181.6K	$1.4M
Thomas Karelis	KY	Internal Medicine Physician	$188.5K	$1M
Ionut Stefanescu Sturz	KY	Internal Medicine Physician	$122.9K	$512.8K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kentucky River Community Care, Inc	KY	Specialist	$0	$109.1M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$107.9M
Kentucky River Community Care, Inc	KY	Mental Health Counselor	$0	$104M
Kentucky River Area Dev Dist	KY	Supports Brokerage Agency	$0	$43.4M
Primary Care Centers Of Eastern Kentucky, LLC	KY	Rural Health Clinic/Center	$0	$26.2M
Soaring Potentials Lllp	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$20.4M
Bhg Xxvi, LLC	KY	Substance Use Disorder Rehabilitation Clinic/Center	$493.7K	$16.1M
Southern Medical Partners, LLC	KY	Emergency Medicine Physician	$0	$15.6M
Dungarvin Kentucky, LLC - Hazard	KY	Developmentally Disabled Services Day Training Agency	$0	$10.1M
Quantum Healthcare Associates Inc	KY	General Practice Physician	$0	$9.1M

Kentucky Pain Management Services — Billing Profile & Reimbursement Data

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Kentucky Pain Management Services — 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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