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NPI 1437175734 · Richmond, VA · General Acute Care Hospital
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Virginia Commonwealth University Health System Authority is a general acute care hospital provider located in Richmond, Virginia. This profile covers 0 Medicare and 1217 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Virginia Commonwealth University Health System Authority |
| Address | 1250 E Marshall St |
| City | Richmond |
| State | VA |
| ZIP | 23298 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | July 14, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $658.3M |
| Medicare | $0 |
This provider reports no Medicare billing on file and $658.3M in lifetime Medicaid revenue, making its financial footprint effectively single-payer (Medicaid) in the available data. Analysts should treat comparisons to Medicare peers as inapplicable for this entity because Medicare activity is absent from the dataset.
Revenue concentration in Medicaid is high: the precomputed top three Medicaid codes account for 43.7% of the provider’s total Medicaid revenue, indicating a heavy reliance on a small set of high-volume services for the majority of Medicaid inflows. This concentration suggests that shifts in utilization or reimbursement for those codes would materially affect the provider’s Medicaid revenue.
G0463 is the single largest Medicaid revenue driver at $120.5M and represents 30.1% of the provider’s total Medicaid revenue; the code ranks #1 of 70 providers in-state and is labeled an "extreme outlier." This strongly indicates the provider operates a very large hospital outpatient clinic assessment and management volume relative to in-state peers, positioning it as a dominant site for outpatient visits.
Emergency department E/M codes (99283, 99284, 99285) together appear as major contributors across the top codes list—99283 ($28.3M, 7.1%), 99284 ($19.4M, 4.9%), and 99285 ($16.2M, 4.0%)—and rank highly statewide (99th, 98th, 97th percentiles). The presence of multiple high-ranking ED codes implies substantial emergency department throughput and that acute care services are a significant operational focus for the health system.
High-volume outpatient evaluation and management office visit codes 99214 ($26.4M, 6.6%) and 99213 ($18.4M, 4.6%) rank in the 100th percentile statewide, reflecting large ambulatory care activity and significant established-patient follow-up care. Coupled with the dominant G0463 volume, this mix signals a combined strength in both hospital-based outpatient clinics and traditional ambulatory visits.
The provider is a statewide leader or extreme outlier for numerous specialty and supportive services: examples include 96110 ($15.8M; 100th percentile), 97110 ($9.4M; 100th percentile), 96366 and 96365 (infusion codes, $6.2M each; 100th percentiles), and J9271 (pembrolizumab, $14.1M; 100th percentile). These rankings indicate broad, high-intensity service lines spanning developmental screening, rehabilitation, infusion/oncology therapies, and advanced pharmaceuticals, consistent with a large tertiary or academic medical center.
Procedural and imaging volumes are substantial and above typical state levels: codes such as 74177 CT abdomen/pelvis ($5.4M; 95th percentile), 70450 CT head ($5.4M; 95th percentile), 93306 echocardiography ($6.3M; 96th percentile), and 77386 IMRT delivery ($6.6M; 100th percentile) show notable activity in diagnostic imaging, cardiac testing, and radiation oncology. This mix supports a profile of comprehensive inpatient/outpatient procedural capability.
This NPI has been enumerated since 2006-07-14 (~20 years), indicating long tenure in the market. The combination of long-standing enrollment and the provider’s repeated #1 statewide rankings across many codes suggests established referral relationships and substantial capacity relative to in-state competitors.
Taken together, the code mix and rank distribution characterize VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY as a dominant Medicaid provider in Virginia with very large outpatient clinic volumes, a high-throughput emergency department, extensive infusion and oncology services, and broad diagnostic/procedural capabilities. The provider’s financial exposure is concentrated in a few codes (top three = 43.7% of Medicaid revenue), making targeted changes in reimbursement or utilization for those services a strategic risk or opportunity for payers and the provider alike.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
1217 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 651,320 | $190 | $120.5M |
| 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. | 115,060 | $250 | $28.3M |
| 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… | 160,140 | $170 | $26.4M |
| 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… | 86,270 | $280 | $24.2M |
| 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. | 83,800 | $230 | $19.4M |
| 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… | 116,760 | $160 | $18.4M |
| 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. | 66,290 | $240 | $16.2M |
| 96110 | The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate… | 25,810 | $610 | $15.8M |
| 96361 | The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration. | 35,000 | $420 | $14.7M |
| J9271 | Injection, pembrolizumab, 1 mg | 2,350 | $6,010 | $14.1M |
Showing 1–10 of 1217
How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Virginia median
1217 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg | 1 | 10 | 3,260 | $1,870 | $6.1M |
| J9271 | Injection, pembrolizumab, 1 mg | 1 | 10 | 800 | $5,190 | $4.6M |
| 96361 | The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration. | 5 | 90 | 9,030 | $280 | $3.2M |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | 4 | 10 | 700 | $1,300 | $2.8M |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 1 | 70 | 3,200 | $110 | $2.8M |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 1 | 10 | 800 | $1,530 | $2.1M |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg | 1 | 10 | 980 | $2,000 | $2M |
| J2350 | Injection, ocrelizumab, 1 mg | 3 | 10 | 20 | $18,310 | $1.9M |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 1 | 30 | 600 | $1,370 | $1.7M |
| 59899 | Use 59899 to report procedures in maternity care and delivery, other than those that employ laparoscopy, that do not have a specific code. | 1 | 10 | 1,440 | $780 | $1.4M |
Showing 1–10 of 1217
Other providers in the same ZIP code as Virginia Commonwealth University Health System Authority, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Dentistry Vcu | VA | Dentist | $0 | $12.5M |
| Matthew Herczyk | VA | Diagnostic Radiology Physician | $750.5K | $47.4K |
| Paul Fang | VA | Diagnostic Radiology Physician | $688K | $0 |
| Tahir Khan | VA | Internal Medicine Physician | $480.4K | $8.9K |
| William Denney | VA | Internal Medicine Physician | $396.1K | $0 |
| Laurie Cuttino | VA | Radiation Oncology Physician | $350.4K | $0 |
| Michelle Garnett | VA | Diagnostic Radiology Physician | $305.4K | $0 |
| Alex Munoz | VA | Diagnostic Radiology Physician | $265.2K | $0 |
| Charlotte Cockrell | VA | Diagnostic Radiology Physician | $264.5K | $0 |
| Tilahun Goshu | VA | Acute Care Nurse Practitioner | $259.1K | $0 |
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