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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

The Moses H. Cone Memorial Hospital Operating Corporation (NPI 1477591055)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Moses H. Cone Memorial Hospital Operating Corporation
Address	1200 N Elm St
City	Greensboro
State	NC
ZIP	27401
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 3, 2006

Payer Source	Total Paid
Medicaid	$133.5M
Medicare	$0

This institution reports no Medicare billing on file and $133.5M in lifetime Medicaid revenue, making it effectively a single-payer (Medicaid) performer in the available claims data rather than a dual-payer hospital. The absence of Medicare activity in the dataset is notable for a General Acute Care Hospital and concentrates analytic attention on Medicaid demand and state-level competitive position.

Revenue is highly concentrated in emergency department evaluation-and-management codes: the top 3 Medicaid codes (99285, 99283, 99284) together account for 76.7% of this provider's total Medicaid revenue. Individually these codes generate $31.7M (26.5%), $31M (25.9%), and $29.1M (24.3%) of Medicaid revenue respectively, signaling that emergency services are the primary driver of the hospital’s Medicaid income.

The code mix indicates core operational emphasis on high ED throughput and acute care: large volumes of 99285 (95K claims, $334 avg paid/claim), 99283 (170.1K claims, $182 avg paid/claim), and 99284 (116.8K claims, $249 avg paid/claim) point to continuous, high-acuity and moderate-acuity emergency care activity. This pattern is consistent with a major acute-care hospital functioning as a regional emergency access point with both high claim counts and substantial per-claim payments for complex ED encounters.

State-level competitive standing is dominant for key ED and monitoring services: the provider ranks #1 of 316 providers in-state for 99283 (100th percentile; extreme outlier), ranks #7 of 281 for 99285 (98th percentile; extreme outlier), and ranks #12 of 325 for 99284 (97th percentile; notably above typical). These rank/percentile signals identify the hospital as a top-tier Medicaid ED volume and severity outlier within North Carolina.

Beyond E/M, the hospital shows unusually high volumes for certain diagnostic/monitoring and lab codes that support an ED- and inpatient-driven case mix. Notable examples include 93005 (62.1K claims, $22 avg paid/claim, $1.4M revenue; ranks #1 of 136 providers in-state, 100th percentile; extreme outlier) and 71046 (37.4K claims, $39 avg paid/claim, $1.5M revenue; ranks #13 of 373, 97th percentile; notably above typical), which indicate heavy ECG and chest imaging throughput tied to acute presentations.

High-volume lab and infectious disease testing appear linked to acute respiratory and sexual health workflows: 87637 (26.7K claims, $178 avg paid/claim, $4.7M revenue; ranks #3 of 89, 98th percentile; notably above typical) and U0003 (12.4K claims, $81 avg paid/claim, $1M revenue; ranks #19 of 158, 89th percentile) show robust respiratory pathogen testing, while 87491 and 87591 (each 54.2K claims, ~$1.8M and $1.7M revenue respectively) highlight sustained STI screening volume.

The provider also posts elevated volumes for infusion and observation-related service codes, consistent with ED-associated treatment and observation care: 96361 (25.7K claims, $44 avg paid/claim, $1.1M revenue; ranks #2 of 104, 99th percentile; extreme outlier) and 96374/96375 (32.7K and 18.2K claims respectively) suggest a substantial throughput of IV medication and fluid administration tied to emergency or outpatient infusion operations.

The hospital’s NPI was enumerated on 2006-06-03 (~20 years ago), indicating long-tenured participation in the claims system. Given the extreme outlier status on several high-revenue Medicaid codes and the concentrated Medicaid-only revenue base, the facility’s financial performance and operational risk are likely highly sensitive to changes in state Medicaid policy, ED reimbursement, or utilization management initiatives.

Medicaid: Complete Services Breakdown

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

274 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	94,990	$330	$31.7M
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.	170,140	$180	$31M
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.	116,830	$250	$29.1M
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	26,660	$180	$4.7M
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	17,210	$120	$2M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	54,230	$30	$1.8M
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.	14,220	$120	$1.8M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	54,210	$30	$1.7M
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	37,410	$40	$1.5M
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	62,100	$20	$1.4M

Showing 1–10 of 274

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

The Moses H. Cone Memorial Hospital Operating Corporation — 17 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

274 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S9484	Crisis intervention mental health services, per hour	27	30	6,730	$510	$3.7M
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.	12	330	6,130	$130	$2.7M
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…	19	160	840	$70	$2.3M
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.	1	320	6,160	$120	$2.1M
T2016	Habilitation, residential, waiver; per diem	58	90	5,520	$190	$1.6M
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.	7	280	2,690	$130	$1.6M
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	4	80	420	$30	$1.2M
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…	382	640	4,280	$60	$983.2K
87661	The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique.	6	70	280	$20	$896.7K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	12	40	420	$1,080	$841K

Showing 1–10 of 274

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alamance Regional Medical Center, Inc.	NC	General Acute Care Hospital	$0	$30.8M
The Moses H Cone Memorial Hospital Operating Corporation	NC	Internal Medicine Physician	$0	$21.6M
The Moses H. Cone Memorial Hospital Operating Corporation	NC	Pediatrics Physician	$0	$21.3M
Timmothy Randell	LA	Orthopaedic Surgery Physician	$561.1K	$0
Said Iskandar	VA	Cardiovascular Disease Physician	$462.9K	$0
Glenn Chrystal	NC	Radiation Oncology Physician	$204.7K	$0
Praveen Mannam	NC	Pulmonary Disease Physician	$197.4K	$0
Jagadeesh Ganji	NC	Cardiovascular Disease Physician	$157.3K	$0
Brian Chen	NC	Vascular Surgery Physician	$139.4K	$0
Katarina Nelson	CO	Cardiovascular Disease Physician	$138.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alston Personal Care Service LLC	NC	In Home Supportive Care Agency	$0	$19.2M
Bayada Home Health Care, Inc.	NC	Developmental Disabilities Clinic/Center	$0	$16.8M
Morgan Support Services, Inc.	NC	Community/Behavioral Health Agency	$0	$12.6M
Guilford County Schools	NC	Local Education Agency (LEA)	$0	$12.5M
Shipman Family Home Care, Inc	NC	Home Health Agency	$0	$10.2M
Alison J Mcmillian	NC	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$10M
Rachel Perenits Dds PA	NC	Dentist	$0	$8.6M
Greensboro Radiology, PA	NC	Diagnostic Radiology Physician	$0	$7.7M
Family Solutions, PLLC	NC	Community/Behavioral Health Agency	$0	$7.1M
Nathan Haines	NC	Retina Specialist (Ophthalmology) Physician	$1.4M	$140

The Moses H. Cone Memorial Hospital Operating Corporation — Billing Profile & Reimbursement Data

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The Moses H. Cone Memorial Hospital Operating Corporation — 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