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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Patel & Patel Md Inc (NPI 1467535450)

Patel & Patel Md Inc is a obstetrics & gynecology physician provider located in South Charleston, West Virginia. This profile covers 0 Medicare and 46 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Patel & Patel Md Inc
Address	401 Division St Ste 306
City	South Charleston
State	WV
ZIP	25309
Taxonomy	Obstetrics & Gynecology Physician
NPI Enumerated	October 23, 2006

Payer Source	Total Paid
Medicaid	$4M
Medicare	$0

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

46 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	18,900	$60	$1.2M
93975	The provider performs a complete study of the abdominal, pelvic, scrotal, and or retroperitoneal organs using duplex ultrasound. He performs the procedure to examine the vascular supply to the organs…	3,620	$130	$477.7K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	5,930	$50	$296.3K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	4,080	$60	$253.1K
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	3,960	$50	$205.7K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	6,300	$30	$189.1K
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…	2,270	$70	$158.6K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	1,910	$70	$137.7K
76856	A pelvic ultrasound is a noninvasive procedure used to assess body parts such as the bladder, ovaries, uterus, cervix, and fallopian tubes in females and the bladder, prostate gland, and seminal…	1,820	$60	$112.5K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	1,140	$70	$83.1K

Showing 1–10 of 46

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Patel & Patel Md Inc — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

46 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	19	40	820	$30	$1.2M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	19	40	820	$30	$1.2M
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	20	20	150	$700	$308.2K
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…	125	1,270	1,240	$30	$245K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	122	190	660	$40	$226.4K
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…	337	1,030	890	$50	$221K
59514	The provider admits the patient to the hospital for delivery, delivers the fetus and placenta via an abdominal incision, and provides care immediately after delivery on the same date of service. This…	8	10	100	$720	$168.5K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	8	50	730	$60	$126.6K
99204	The provider sees a new 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 provider…	110	340	140	$90	$97.5K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	102	130	200	$70	$82.4K

Showing 1–10 of 46

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Urgent Care, Inc.- West Virginia	WV	Urgent Care Clinic/Center	$0	$66.9M
Herbert J. Thomas Memorial Hospital Association	WV	General Acute Care Hospital	$0	$26.1M
Mountaineer Family Medicine, Inc.	WV	Family Medicine Physician	$0	$19.5M
Ths Physician Partners Inc	WV	Internal Medicine Physician	$0	$9.2M
Appalachian Medical LLC	WV	Durable Medical Equipment & Medical Supplies	$0	$8M
Pulmonary Associates Of Char LLC	WV	Pulmonary Disease Physician	$0	$5.5M
Maccorkle Emergency Physicians PLLC	WV	Emergency Medicine Physician	$0	$4.4M
Wecare Medical LLC	WV	Oxygen Equipment & Supplies (DME)	$0	$3.7M
Woman Care Clinic Inc	WV	Obstetrics & Gynecology Physician	$0	$3.5M
Lincoln County Primary Care Center, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$2.7M

Patel & Patel Md Inc — Billing Profile & Reimbursement Data

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Patel & Patel Md Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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