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

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

Texas Children's Hospital (NPI 1477643690)

Key Findings

Field	Value
Entity Type	Organization
Organization	Texas Children's Hospital
Address	6621 Fannin St
City	Houston
State	TX
ZIP	77030
Taxonomy	Children's Hospital
NPI Enumerated	October 16, 2006

Payer Source	Total Paid
Medicaid	$277.4M
Medicare	$0

TEXAS CHILDREN'S HOSPITAL is effectively a Medicaid-focused provider: there is no Medicare revenue on file and total Medicaid revenue is $277.4M, indicating the provider’s public-payer exposure is concentrated in Medicaid rather than Medicare. This billing profile should be interpreted as single-payer (Medicaid) dominant for the period on file rather than a mixed Medicare/Medicaid operation.

Revenue concentration is high: the precomputed top 3 Medicaid codes by revenue account for 62.3% of this provider’s total Medicaid revenue, with 99285 (34.4%), 99284 (22.5%), and 97110 (5.4%) identified as the primary revenue drivers. That concentration around a small set of codes suggests financial sensitivity to utilization patterns or policy changes affecting emergency department E/M and pediatric therapy services.

The code mix points to a large, high-acuity pediatric emergency and procedural operation: the two largest revenue drivers are emergency department E/M codes 99285 and 99284, and observation services (G0378) also appear among high-revenue items. High unit payments and state-leading volumes on these ED codes (99285 ranks #6 of 587 in-state, 99th percentile; 99284 ranks #26 of 714, 96th percentile) indicate a major pediatric ED/acute-care throughput capability.

Beyond ED care, the provider operates broad specialty services for children: high volumes and revenues in therapeutic services (97110, 97530), audiology and infant hearing (92567, 92579, 92507), ENT procedures (42820, 69436), dental procedures (41899), imaging (70553, 93306, 93303), and lab/testing (87635, , ) reflect integrated outpatient and inpatient pediatric specialty lines. Many of these codes have above-typical or extreme state volumes (e.g., ranks #11 of 1319, 99th percentile; ranks #40 of 1616, 98th percentile), supporting a multidisciplinary pediatric service footprint.

State-level competitive standing is strong and in some areas dominant: the provider shows multiple top-in-state positions or near-top ranks (95004 rank #1 of 151, 100th percentile; G0378 rank #1 of 73, 100th percentile; 87632 rank #1 of 15, 100th percentile; 92567 rank #1 of 235, 100th percentile; 92579 rank #1 of 69, 100th percentile). Several other high-revenue codes are described as “extreme outlier” or “notably above typical state volume,” indicating the hospital functions as a referral and volume center for pediatric services in Texas.

Several individual codes are statistical outliers in state comparisons, which signals concentrated specialty volume rather than routine community practice: for example, 99285 is labeled an extreme outlier (99th percentile), 97110 is an extreme outlier (99th percentile), and 87635 (SARS–COV–2 testing) is an extreme outlier (100th percentile). These outlier designations should be interpreted as indicators of unusually high pediatric volume or specialized testing patterns relative to peers, which has operational and reimbursement implications for payer negotiations and network planning.

Operational implications for care delivery and capacity are clear: the dominance of high-acuity ED codes and procedure codes such as 42820 (tonsil/adenoid removal) and 69436 (tympanostomy) points to sizable OR and perioperative demand in addition to emergency throughput. High volumes in therapy and rehabilitative codes (97110, 97112, 97530) and repeated top ranks in audiology/ENT testing suggest substantial outpatient therapy and allied-health staffing requirements integrated with inpatient services.

The provider’s NPI has long tenure, enumerated on 2006-10-16 (~20 years ago), indicating an established presence in the market. Combined with the statewide dominance on multiple pediatric service codes, this longevity supports the view that TEXAS CHILDREN'S HOSPITAL is a mature, specialty-centered pediatric system with entrenched referral relationships and scale in Medicaid-funded pediatric care.

Medicaid: Complete Services Breakdown

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

400 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.	84,140	$960	$80.5M
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.	66,210	$800	$52.7M
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…	56,220	$220	$12.6M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	3,610	$2,250	$8.1M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	3,240	$2,450	$8M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	32,140	$230	$7.5M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	72,370	$70	$4.8M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	2,820	$1,650	$4.7M
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…	38,390	$120	$4.5M
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	11,570	$380	$4.4M

Showing 1–10 of 400

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Texas Distribution

Texas Children's Hospital — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. Texas median

400 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97124	Generally, massage is a technique of applying light or firm pressure, with different movement styles, using palms, fingers, and thumbs, over body muscles and tissues in order to restore better blood…	41	40	3,120	$100	$2.3M
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.	26	710	1,790	$200	$2.1M
A0430	Ambulance service, conventional air services, transport, one way (fixed wing)	7	10	310	$2,690	$1.5M
A0435	Fixed wing air mileage, per statute mile	7	10	310	$2,170	$1.2M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	10	70	370	$760	$1M
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.	27	730	1,960	$100	$1M
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.	6	590	740	$170	$969.2K
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…	76	1,350	1,860	$80	$872.4K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	3	10	140	$5,060	$799.6K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	23	30	330	$1,020	$750.2K

Showing 1–10 of 400

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Texas Children's Physician Group	TX	Pediatrics Physician	$0	$160.6M
Ut Physicians	TX	Anesthesiology Physician	$0	$94.4M
Texas Children's Urgent Care	TX	Pediatrics Physician	$0	$63.7M
Memorial Hermann Health System	TX	General Acute Care Hospital	$0	$39.5M
Harris County Hospital District	TX	General Acute Care Hospital	$0	$27.7M
Baylor College Of Medicine	TX	Family Medicine Physician	$0	$18.1M
Igor Cherches	TX	Neurology Physician	$6.7M	$0
David Brown	TX	Ophthalmology Physician	$5.7M	$0
Tien Wong	TX	Ophthalmology Physician	$4.5M	$0
Ankoor Shah	TX	Ophthalmology Physician	$3.7M	$0

Texas Children's 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

Nearby Providers

Frequently Asked Questions

References