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

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

Erlanger Health (NPI 1477256303)

Erlanger Health is a internal medicine physician provider located in Chattanooga, Tennessee. This profile covers 0 Medicare and 102 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	Erlanger Health
Address	979 E 3rd St Ste A440
City	Chattanooga
State	TN
ZIP	37403
Taxonomy	Internal Medicine Physician
NPI Enumerated	March 22, 2023

Payer Source	Total Paid
Medicaid	$2.3M
Medicare	$0

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

102 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	18,900	$40	$794K
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…	9,510	$30	$313.7K
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…	2,360	$50	$118.1K
96160	The provider administers a questionnaire aimed at helping to identify a specific health risk to a patient, analyzes the results, assigns a score, and documents the findings. Use this code for each…	5,190	$20	$108.9K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	1,150	$80	$90.5K
99392	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…	1,640	$50	$85.1K
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…	3,760	$20	$82.7K
99203	The provider sees a new 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 provider…	1,320	$60	$81.6K
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…	920	$80	$71.8K
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…	520	$100	$52.7K

Showing 1–10 of 102

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Erlanger Health — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

102 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	13	10	1,710	$90	$1M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	19	20	890	$100	$997K
J0585	Injection, onabotulinumtoxina, 1 unit	13	20	200	$880	$709.1K
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…	170	360	350	$50	$414.4K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	96	150	390	$60	$220.9K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	143	170	340	$190	$206.8K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	140	610	1,220	$40	$206K
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…	168	3,760	610	$40	$202.3K
99392	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…	145	520	470	$70	$187K
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…	418	4,050	620	$30	$183.9K

Showing 1–10 of 102

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Chattanooga Hamilton County Hospital Authority	TN	General Acute Care Hospital	$0	$52.4M
Chattanooga Hamilton County Hospital Authority	TN	Internal Medicine Physician	$0	$27.9M
Chattanooga Hamilton County Hospital Authority	TN	Critical Access Hospital	$0	$5.6M
Erlanger Health	TN	General Acute Care Hospital	$0	$3.3M
Erlanger Behavioral Health, LLC	TN	Psychiatric Hospital	$0	$2.2M
Medical Foundation, Inc.	MS	Geriatric Medicine (Family Medicine) Physician	$0	$1.8M
Clint Kingsley	AL	Hematology & Oncology Physician	$1.6M	$22K
Robert Graham	TN	Hematology & Oncology Physician	$1.2M	$19.8K
Harsha Vardhana	TN	Medical Oncology Physician	$941.1K	$66.6K
Sreejit Nair	NC	Vascular Surgery Physician	$658K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Regional Obstetrical Consultants PC	TN	Maternal & Fetal Medicine Physician	$0	$14.2M
Tennessee River Physicians, PLLC	TN	Emergency Medicine Physician	$0	$3.9M
Southeastern Emergency Services Of Memphis, P.C.	TN	Emergency Medicine Physician	$0	$3.8M
Tennessee Interventional And Imaging Associates, PLLC	TN	Diagnostic Radiology Physician	$0	$3.4M
Hearth Hospice Of Tennessee, LLC	TN	Community Based Hospice Care Agency	$0	$2.8M
Sumana Nagireddy	TN	Hematology & Oncology Physician	$836.4K	$0
Brett Gerwin	TN	Ophthalmology Physician	$725.5K	$60
Michael Goodman	TN	Gastroenterology Physician	$473.6K	$0
Harigovinda Challa	TN	Diagnostic Radiology Physician	$154.9K	$257.6K
David Bowers	TN	Physical Medicine & Rehabilitation Physician	$410.4K	$0

Erlanger Health — Billing Profile & Reimbursement Data

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Erlanger Health — 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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