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NPI 1467492421 · Edgewood, KY · General Acute Care Hospital
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St Elizabeth Medical Center, Inc is a general acute care hospital provider located in Edgewood, Kentucky. This profile covers 14 Medicare and 628 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 | St Elizabeth Medical Center, Inc |
| Address | 1 Medical Village Dr |
| City | Edgewood |
| State | KY |
| ZIP | 41017 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | June 7, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $188.3M |
| Medicare | $41.7K |
Provider is overwhelmingly Medicaid-facing: reported lifetime Medicaid revenue is $188.3M versus total Medicare revenue of $41.7K, indicating Medicaid accounts for the vast majority of billed dollars and Medicare activity is quantitatively negligible. The NPI was enumerated on 2006-06-07 (~20 years ago), so this entity has an established operating history in the market.
Medicare revenue is highly concentrated in portable radiography codes: the top three Medicare codes account for 79.0% of Medicare revenue, driven primarily by R0070 (49.0% of Medicare revenue), with Q0092 (16.0%) and R0075 (14.0%) making up the remainder. The code mix implies the provider’s Medicare activity is dominated by mobile/portable X‑ray services to homes or nursing facilities rather than a broad set of inpatient or outpatient hospital procedures.
Despite those Medicare concentrations, the provider’s national competitive standing on those Medicare radiology codes is modest: R0070 ranks #218 of 285 nationally (24th percentile; typical, unremarkable volume), Q0092 ranks #210 of 285 (26th percentile; typical, unremarkable volume), and R0075 ranks #134 of 201 (34th percentile; typical, unremarkable volume). In other words, its Medicare portable X‑ray billing is concentrated but not large relative to national peers.
Medicaid revenue is concentrated in emergency department E/M services: the top three Medicaid codes account for 47.0% of Medicaid revenue, with 99283 at $26.3M (23.0% of Medicaid revenue), 99284 at $17.9M (15.7%), and 99285 at $9.5M (8.3%). This mix indicates the hospital’s Medicaid business line is driven by ED visits across low-to-high acuity E/M levels and positions the ED as a primary revenue center for Medicaid.
Within the state competitive context, the provider is a high-volume ED and lab player: 99283 ranks #5 of 284 in-state (99th percentile; notably above typical state volume), 99284 ranks #18 of 282 (94th percentile), and 99282 ranks #3 of 158 (99th percentile; extreme outlier, far above typical state volume). Similarly, core specimen collection and testing codes are extreme outliers in-state (36415: 428.6K claims, rank #2 of 731, 100th percentile; 80307: 70.4K claims, rank #17 of 342, 95th percentile), supporting a picture of very high ED throughput and associated lab volumes.
Clinical capability indicators beyond the ED reinforce acute hospital services: notable Medicaid activity and high-percentile ranks appear for services such as CT abdomen/pelvis with contrast 74177 (14.7K claims, $3.1M), imaging supervision for left heart catheterization 93458 (1.6K claims, $2.3M), transthoracic echo 93306 (7.6K claims, $2.2M), and chemotherapy 96413 (11.6K claims, $2.9M). These line items suggest the provider operates a broad set of acute-care services including advanced imaging, interventional cardiology imaging, diagnostic cardiology, and infusion/oncology capabilities that support its Medicaid revenue base.
High-volume, state-level testing and drug-administration codes point to substantial outpatient and ED ancillary revenue streams: U0003 (44.8K claims, $3.3M, rank #5 of 106, 96th percentile), G0480 (49.2K claims, $4.1M, rank #7 of 141, 96th percentile), and J3490 (145.8K claims, $2M, rank #2 of 104, 99th percentile) indicate consistent specimen and drug billing that accompanies the ED and observation workload. These patterns reinforce that lab/ancillary services are material contributors to Medicaid revenue and competitive positioning in-state.
From a contracting and analytic perspective, the provider’s Medicaid dependence and ED-centric revenue concentration (top three Medicaid codes = 47.0% of Medicaid revenue) are the most salient business risks/opportunities; by contrast, Medicare revenue is both tiny in absolute terms ($41.7K) and concentrated in portable X‑ray codes (top three = 79.0% of Medicare revenue) but ranks modestly against national peers. Analysts should treat Medicaid ED volumes, associated lab/testing throughput, and high-percentile in-state ranks as the primary operational levers and benchmarking comparators when evaluating network value or utilization management strategies.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
14 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| R0070 | Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen | 250 | $80 | $20.4K |
| Q0092 | Set-up portable x-ray equipment | 420 | $20 | $6.7K |
| R0075 | Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen | 170 | $40 | $5.8K |
| 71045 | In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby… | 240 | $20 | $4.1K |
| 74018 | Report this code for one X–ray view of the structures and organs in the abdomen to diagnose certain abdominal problems. | 50 | $20 | $950 |
| 73502 | In this diagnostic procedure, the provider takes X–ray images of one hip, either left or right, from two or three projections (directions or angles) to check for any fracture, swelling, or other… | 20 | $30 | $580 |
| 72100 | The technician takes 2 or 3 views of the vertebrae in the lumbar region which is the lower part of the spine and the sacrum, the area that connects the spine to the pelvis. Lumbosacral spine X–rays… | 20 | $30 | $540 |
| 73030 | This particular procedure is for a minimum of 2 X–ray views of the complete shoulder. | 20 | $30 | $500 |
| 73620 | In this diagnostic procedure, the provider takes two X–ray views of a patient’s foot to assess an injury, fracture, arthritis, tumor, or congenital abnormality. | 30 | $20 | $440 |
| 73560 | In this procedure, the provider takes one or two X–ray images of a patient’s knee joint to check for any fracture, swelling, or reason for pain in the knee area. | 20 | $30 | $420 |
Showing 1–10 of 14
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
628 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. | 115,680 | $230 | $26.3M |
| 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. | 53,270 | $340 | $17.9M |
| 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. | 25,230 | $380 | $9.5M |
| 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. | 38,670 | $150 | $5.7M |
| 96374 | The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition. | 46,790 | $90 | $4.4M |
| G0378 | Hospital observation service, per hour | 20,060 | $210 | $4.2M |
| 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. | 70,350 | $60 | $4.2M |
| J9271 | Injection, pembrolizumab, 1 mg | 570 | $7,120 | $4.1M |
| G0480 | 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… | 49,230 | $80 | $4.1M |
| 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… | 44,770 | $70 | $3.3M |
Showing 1–10 of 628
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
628 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 6 | 10 | 810 | $7,760 | $8.7M |
| 97535 | A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease. | 108 | 310 | 830 | $120 | $3.7M |
| 77386 | Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex | 5 | 10 | 4,350 | $560 | $3.3M |
| 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. | 18 | 280 | 7,150 | $150 | $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. | 32 | 240 | 4,710 | $150 | $2.6M |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 5 | 10 | 140 | $3,650 | $2.5M |
| 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. | 5 | 280 | 5,700 | $120 | $2M |
| 74177 | The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs. | 16 | 180 | 1,870 | $280 | $1.5M |
| G0378 | Hospital observation service, per hour | 7 | 90 | 2,770 | $190 | $1.3M |
| C1776 | Joint device (implantable) | 6 | 20 | 130 | $2,890 | $1.1M |
Showing 1–10 of 628
Other providers in the same ZIP code as St Elizabeth Medical Center, Inc, ranked by combined Medicare and Medicaid revenue.
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