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

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

Kaiser Foundation Health Plan Inc (NPI 1407862030)

Key Findings

Field	Value
Entity Type	Organization
Organization	Kaiser Foundation Health Plan Inc
Address	711 Kapiolani Blvd
City	Honolulu
State	HI
ZIP	96813
Taxonomy	Health Maintenance Organization
NPI Enumerated	August 1, 2006

Payer Source	Total Paid
Medicaid	$7.4M
Medicare	$0

KAISER FOUNDATION HEALTH PLAN INC shows effectively single-payer billing activity in our dataset: there is no Medicare revenue on file while total Medicaid revenue is $7.4M. The entity’s NPI was enumerated on 2006-08-01 (~20 years ago), indicating a long-tenured presence in the Hawaii market rather than a recent entrant.

Revenue for this provider is highly concentrated in a small set of Medicaid services: the top 3 Medicaid codes by revenue (90837, 97110, 87804) account for 61.8% of its total Medicaid revenue. Those three codes individually are 90837: $2.1M (29.5%); 97110: $1.6M (23.1%); and 87804: $644.6K (9.3%), showing the bulk of billing is driven by a narrow set of outpatient therapy and diagnostic services.

The code mix points to an operational focus on behavioral health, rehabilitation, and in‑office diagnostic testing: high-revenue psychotherapy code 90837 and shorter psychotherapy code 90834 appear alongside physical therapy mainstay 97110 and related evaluation code 97161, while influenza testing 87804 and routine labs (85025, 80051) indicate embedded point-of-care or in-network lab capacity. This combination is consistent with an integrated HMO model that delivers mental health, therapy, and basic lab services under one billing umbrella.

By competitive standing in-state, the provider is a major participant for several top services. 90837 ranks #8 of 441 providers in Hawaii (98th percentile) and is described as notably above typical state volume; 97110 ranks #8 of 110 (94th percentile) and is also notably above typical state volume; 87804 ranks #5 of 79 (95th percentile) and is described as notably above typical state volume — each ranking signals above-average market share for these specific services.

High claims volumes reinforce the operational intensity behind the revenue figures: 97110 records 12.9K claims and $1.6M revenue, while 90837 records 7.8K claims and $2.1M revenue, indicating sustained throughput in outpatient therapeutic and psychotherapy encounters rather than one-off high-dollar procedures. These counts suggest routine, repeated care delivery for these service lines.

Core office evaluation-and-management codes are not the primary revenue drivers and sit at mid-to-lower relative volumes compared with peers. For example, 99214 generated $130.8K (513 claims) and ranks #384 of 690 providers in-state (44th percentile) and 99213 generated $42.2K (269 claims) and ranks #449 of 707 providers in-state (37th percentile), both labeled typical or unremarkable volume — this indicates the provider’s Medicaid billing emphasis is on therapy/diagnostic services rather than elevated general outpatient E&M volume.

The provider maintains a meaningful lab and diagnostic footprint that supplements therapy and behavioral health work: 85025 brought in $285.2K (10.6K claims, 4.1%), 81001 brought in $214.7K (15.3K claims, 3.1%), and 80051 brought in $129.3K (4.5K claims, 1.9%); these codes rank in higher percentiles for in-state peers and are characterized as typical to above-typical volumes. This mix supports in-network testing capacity that likely reduces referrals out of system for routine diagnostics.

Because there is no Medicare billing on file, the provider’s revenue profile is concentrated in Medicaid payment streams and subject to state Medicaid program dynamics. Combined with the 61.8% concentration in three codes, this pattern should be interpreted as concentrated service-line exposure that will make overall revenue particularly sensitive to Medicaid reimbursement changes or shifts in demand for psychotherapy, physical therapy, and point-of-care infectious disease testing.

Medicaid: Complete Services Breakdown

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

76 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	7,840	$260	$2.1M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	12,880	$130	$1.6M
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	5,370	$120	$644.6K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	2,500	$200	$502.3K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	10,560	$30	$285.2K
81001	Urinalysis is used to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is used to detect urinary tract infections (UTI) and other…	15,340	$10	$214.7K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1,530	$110	$162.3K
98968	A nonphysician qualified healthcare professional discusses, via telephone, a health issue and possible treatment or management with an established patient, parent, or guardian. This service includes…	2,210	$70	$161.2K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	4,590	$30	$133.2K
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…	510	$260	$130.8K

Showing 1–10 of 76

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Kaiser Foundation Health Plan Inc — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

76 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	62	70	370	$150	$457.3K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	14	20	600	$50	$345.9K
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…	449	710	650	$90	$274.1K
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…	384	690	650	$90	$235.4K
98968	A nonphysician qualified healthcare professional discusses, via telephone, a health issue and possible treatment or management with an established patient, parent, or guardian. This service includes…	2	10	490	$190	$172.3K
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,…	43	190	190	$100	$122.8K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	13	80	320	$100	$119.2K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	18	100	210	$120	$116.7K
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…	8	440	500	$90	$116.1K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	8	110	1,000	$40	$108.5K

Showing 1–10 of 76

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kaiser Foundation Hospitals	HI	General Acute Care Hospital	$0	$76.5M
Yi Zheng	CA	Gastroenterology Physician	$199.6K	$118.3K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Queens Medical Center	HI	General Acute Care Hospital	$0	$200M
Straub Clinic & Hospital	HI	General Acute Care Hospital	$0	$45.6M
State Of Hawaii Dept. Of Health Adult Mental Health Division	HI	Community/Behavioral Health Agency	$0	$29.3M
Positive Behavior Supports Corporation	HI	Community/Behavioral Health Agency	$0	$26.4M
Easter Seals Hawaii	HI	Developmentally Disabled Services Day Training Agency	$0	$16.8M
The Emergency Group, Inc.	HI	Emergency Medicine Physician	$0	$15M
Hawaii Dental Group, Inc.	HI	General Practice Dentistry	$0	$12.4M
The Queen's Medical Center	HI	General Acute Care Hospital	$0	$10.3M
Hawaii Home Care Inc	HI	Nursing Care Agency	$0	$9.3M
Evergreen Adult Day Care	HI	Adult Day Care Clinic/Center	$0	$8.9M

Kaiser Foundation Health Plan Inc — 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