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

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

Methodist Healthcare - Memphis Hospitals (NPI 1386709871)

Field	Value
Entity Type	Organization
Organization	Methodist Healthcare - Memphis Hospitals
Address	848 Adams Ave
City	Memphis
State	TN
ZIP	38103
Taxonomy	Children's Hospital
NPI Enumerated	December 26, 2006

Payer Source	Total Paid
Medicaid	$84.4M
Medicare	$0

Key Findings

This provider is effectively single‑payer in the available claims data: there is no Medicare billing on file and the provider reports $84.4M in total Medicaid revenue, indicating operations are materially concentrated in the Medicaid population. The absence of Medicare billing should reframe comparative benchmarking and contracting conversations — analyses should focus on Medicaid performance and state peer comparisons rather than Medicare benchmarks.

Revenue concentration is high: the precomputed top‑3 Medicaid codes account for 55.7% of this provider's total Medicaid revenue, driven by 99283 ($21.2M revenue; 28.6% of total), 99284 ($13.6M; 18.3%), and G0378 ($6.5M; 8.8%). This concentration shows that a majority of Medicaid dollars flow through a narrow set of acute and observation services rather than a broad mix of outpatient procedures.

The code mix points to an emergency/observation‑centric operational model. Multiple high‑revenue E/M ED codes (99283, 99284, 99285, 99282) together with G0378 (hospital observation service) indicate the hospital functions as a high‑volume acute access point with substantial observation‑unit throughput rather than a typical ambulatory surgery center.

Competitive standing within Tennessee is dominant for several acute services. 99283 ranks #6 of 611 providers in‑state (99th percentile; extreme outlier) and G0378 ranks #1 of 96 (100th percentile; extreme outlier), which positions the hospital as a major statewide provider of low‑level ED visits and hospital observation services. Several lab and respiratory codes also show extreme statewide standing (for example, 87635 and 87400 both rank #1 in‑state at the 100th percentile), underscoring the facility's role as a high‑volume testing and acute respiratory care center.

Clinical mix includes a clear pediatric specialty footprint consistent with the Children's Hospital taxonomy. Procedural and diagnostic codes commonly used in pediatrics and pediatric ENT—42820 (tonsil/adenoid removal, $2.4M, 3.2%), 69436 (tympanostomy, $1.5M, 2.0%), and infant hearing services such as 92587 (8.5K claims, $990.1K, 1.3%)—appear among top codes, indicating substantial surgical and newborn/infant diagnostic care.

Outpatient clinic and primary care throughput is also material: 99213 accounts for $5.1M (6.9%) with 74.1K claims and ranks in the 99th percentile statewide, and G0463 (hospital outpatient clinic visit) contributes $4.8M (6.4%) and ranks #7 of 62 providers (90th percentile). These volumes suggest the provider combines high ED/observation activity with sizable routine outpatient follow‑up and clinic evaluation capacity.

Several codes are statistical outliers in the state, which has operational and contracting implications. Beyond the ED/observation outlier designations, the provider is an extreme outlier for testing codes (87635 rank #1 of 377, 100th percentile; 87400 rank #1 of 56, 100th percentile) and respiratory therapy (94640 rank #1 of 209, 100th percentile), signaling unusually high volumes that payers should evaluate for network capacity, payment arrangements, and utilization management.

The provider has long tenure in the dataset, with NPI enumeration on 2006-12-26 (~20 years ago); this sustained presence is consistent with the high volumes and dominant in‑state ranks observed and suggests these patterns reflect an established operating model rather than a recent fluctuation.

Medicaid: Complete Services Breakdown

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

270 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.	131,830	$160	$21.2M
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.	51,430	$270	$13.6M
G0378	Hospital observation service, per hour	11,310	$580	$6.5M
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…	74,090	$70	$5.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	36,670	$130	$4.8M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	6,180	$490	$3M
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.	9,490	$260	$2.5M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	1,050	$2,260	$2.4M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	41,410	$40	$1.8M
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.	19,430	$80	$1.5M

Showing 1–10 of 270

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Methodist Healthcare - Memphis Hospitals — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

270 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	7	60	1,340	$50	$1.1M
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.	20	630	510	$120	$1.1M
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.	6	610	570	$110	$884.4K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	2	30	410	$520	$719.2K
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.	60	570	640	$100	$637.8K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	89	230	2,130	$40	$616.8K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	7	50	140	$850	$541.1K
82542	The lab analyst performs the technical lab test to evaluate the specimen for the presence or amount of a nondrug analyte by using column chromatography and possibly mass spectrometry.	4	10	550	$10	$499K
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…	9	30	1,060	$130	$484.1K
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.	9	10	1,440	$370	$450.5K

Showing 1–10 of 270

Related Providers

Other providers that share a Tax Identification Number (TIN) with Methodist Healthcare - Memphis Hospitals, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Methodist Healthcare - Memphis Hospitals	TN	General Acute Care Hospital	$0	$105.6M
Ut Lebonheur Pediatric Specialists, Inc.	TN	Pediatrics Physician	$0	$63.8M
Primary Care Group LLC	TN	Family Medicine Physician	$0	$23.5M
Methodist Healthcare - Olive Branch Hospital	MS	General Acute Care Hospital	$0	$18.1M
Alliance Health Services Inc.	TN	Durable Medical Equipment & Medical Supplies	$0	$11.2M
Methodist Inpatient Physicians LLC	TN	Internal Medicine Physician	$0	$4.8M
Lebonheur Patient Transportation	TN	Land Ambulance	$0	$4.5M
Specialty Physician Group LLC	TN	Cardiovascular Disease Physician	$0	$3.3M
Methodist Healthcare - Memphis Hospitals	TN	Children's Hospital	$0	$3.3M
Ut Methodist Physicians LLC	TN	Internal Medicine Physician	$0	$2.7M

Nearby Providers

Other providers in the same ZIP code as Methodist Healthcare - Memphis Hospitals, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shelby County Health Care Corporation	TN	General Acute Care Hospital	$0	$56.1M
City Of Memphis General City Govt.	TN	Land Ambulance	$3.8M	$52M
Pediatric Emergency Specialists, PC	TN	Pediatric Emergency Medicine (Emergency Medicine) Physician	$0	$39.1M
Ut Regional One Physicians Inc	TN	Surgery Physician	$0	$24.1M
Meritan, Inc	TN	Home Health Agency	$0	$16.9M
Pediatric Anesthesiologists P A	TN	Anesthesiology Physician	$0	$4.4M
University Of Tennessee	TN	Dentist	$0	$3.1M
Ut Regional One Physicians Inc	TN	Anesthesiology Physician	$0	$2.3M
Utmg Dermatopathology, LLC	TN	Clinical Medical Laboratory	$1.5M	$127.6K
Hamilton Eye Institute Surgery Center, L.P.	TN	Ambulatory Surgical Clinic/Center	$1M	$1.1K

Methodist Healthcare - Memphis Hospitals — 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