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.

Kauai Veterans Memorial Hospital (NPI 1467510743)

Key Findings

Field	Value
Entity Type	Organization
Organization	Kauai Veterans Memorial Hospital
Address	4643 Waimea Canyon Drive
City	Waimea
State	HI
ZIP	96796
Taxonomy	Critical Access Hospital
NPI Enumerated	December 5, 2006

Payer Source	Total Paid
Medicaid	$6.2M
Medicare	$0

This facility is effectively a single‑payer Medicaid provider: there is no Medicare billing on file and reported lifetime Medicaid revenue is $6.2M, so all reimbursed activity in the dataset is Medicaid‑sourced. The absence of any Medicare activity should be treated as a defining characteristic of its payer mix rather than an incidental detail.

Revenue is extremely concentrated in emergency department evaluation-and-management codes: 99283, 99284, and 99285 together account for 87.3% of the provider’s total Medicaid revenue. Individually those codes represent $2.8M (99283, 44.3%), $1.5M (99284, 24.5%), and $1.2M (99285, 18.6%) of the $6.2M Medicaid total, indicating the ED is the primary revenue driver.

The code mix signals an operational focus on acute and emergency care: the three highest-revenue codes are ED E/M visits (99283–99285), which implies the hospital functions largely as an emergency access point for Medicaid patients. Other service lines—imaging, basic labs, and observation—appear ancillary by comparison, contributing only small shares of revenue.

On competitive standing within the state, the hospital is a modest, middle‑of‑the‑pack participant for its ED volumes rather than a dominant provider. For 99283 it ranks #24 of 45 providers (48th percentile; typical, unremarkable volume), 99284 ranks #24 of 47 (50th percentile; typical, unremarkable volume), and 99285 ranks #27 of 39 (32th percentile; typical, unremarkable volume).

Ancillary and observation utilization is limited relative to in‑state peers: CT abdomen/pelvis with contrast 74177 generated $56.1K (0.9% of Medicaid revenue) and ranks #29 of 36 (20th percentile), while hospital observation hours G0378 amounted to $5.3K (0.1%) and ranks #12 of 13 (8th percentile). These data suggest imaging and formal observation stay billing are secondary to ED throughput.

The provider reports substantial volumes of low‑acuity and moderate‑acuity ED visits alongside fewer high‑acuity visits, which is consistent with a community critical access hospital that manages a broad case mix in the ED. The claim counts (e.g., 8.2K claims for 99283, 3.7K for 99284, 1.5K for 99285) reflect ED visit volumes that drive the institution’s Medicaid revenue profile.

Operationally and financially, the hospital’s reliance on a narrow set of ED E/M codes (87.3% concentration) makes its Medicaid revenue sensitive to changes in ED visit patterns, reimbursement policy, or local payer enrollment shifts. Absent Medicare revenue, any policy or market change affecting Medicaid could disproportionately impact this provider’s topline.

The provider has longstanding billing presence: NPI enumerated (registered) 2006-12-05 (~20 years ago), indicating two decades of enrollment that can be used as context when assessing trend stability or contract history within the local market.

Medicaid: Complete Services Breakdown

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

79 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.	8,170	$340	$2.8M
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.	3,740	$410	$1.5M
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.	1,470	$790	$1.2M
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.	2,100	$280	$592.2K
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.	50	$1,170	$56.1K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	240	$120	$30.1K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	360	$80	$29K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	590	$30	$16.6K
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…	250	$50	$12.1K
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.	2,250	$10	$11.3K

Showing 1–10 of 79

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

Kauai Veterans Memorial Hospital — 0 of 22 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

79 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	24	50	8,590	$340	$5.2M
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.	24	50	3,740	$290	$3.8M
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.	27	40	3,820	$330	$3.3M
G0378	Hospital observation service, per hour	12	10	3,250	$480	$2.3M
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.	17	30	2,660	$330	$1.5M
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.	29	40	1,050	$510	$1.3M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	23	30	770	$430	$536.6K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	23	30	1,750	$70	$378K
77067	The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software…	30	30	1,370	$110	$333.9K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	12	10	1,480	$30	$317.3K

Showing 1–10 of 79

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Samuel Mahelona Memorial Hospital	HI	Critical Access Hospital	$0	$7M
Minghsun Liu	CA	Infectious Disease Physician	$952.7K	$418.7K
Samuel Mahelona Memorial Hospital	HI	Rural Health Clinic/Center	$0	$397.7K
Samuel Mahelona Memorial Hospital	HI	Rural Health Clinic/Center	$0	$342.5K
Kauai Veterans Memorial Hospital	HI	Specialist	$0	$295.4K
Brandon Mason	OK	Diagnostic Radiology Physician	$277.6K	$0
Amanda Marn	HI	Cardiovascular Disease Physician	$194.9K	$0
John Funai	HI	Cardiovascular Disease Physician	$166.3K	$0
Pradeep Bollu	SC	Neurology Physician	$137.1K	$0
Jean Shein	HI	Ophthalmology Physician	$118.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hoola Lahui Hawaii	HI	Federally Qualified Health Center (FQHC)	$0	$2.3M
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.7M
Brian Newman	HI	Internal Medicine Physician	$54K	$0
Robert Millard	HI	Anesthesiology Physician	$6.1K	$0

Kauai Veterans Memorial Hospital — Billing Profile & Reimbursement Data

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Kauai Veterans Memorial Hospital — 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