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

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

Scl Health Medical Group-butte LLC (NPI 1477869600)

Key Findings

Field	Value
Entity Type	Organization
Organization	Scl Health Medical Group-butte LLC
Address	400 S Clark St
City	Butte
State	MT
ZIP	59701
Taxonomy	Family Medicine Physician
NPI Enumerated	August 25, 2010

Payer Source	Total Paid
Medicaid	$9.9M
Medicare	$0

This provider is effectively a single-payer Medicaid operation: there is no Medicare billing on file while total Medicaid revenue is reported as $9.9M. The absence of Medicare claims suggests payer exposure and contract negotiations are concentrated in the Medicaid market rather than split between Medicare and Medicaid.

Revenue is highly concentrated in three codes: the precomputed top‑3 Medicaid codes account for 66.4% of the provider’s total Medicaid revenue, driven primarily by 99213 ($2.6M, 26.9%), 99284 ($2.2M, 22.3%), and 99214 ($1.7M, 17.2%). These three codes indicate the business mix is dominated by routine office E/M and emergency department E/M services, so operational capacity is likely split between primary care visits and ED throughput.

High-volume office E/M activity is a core service line: 99213 has 33.4K claims and $2.6M revenue (26.9%) and ranks #15 of 523 providers in-state (97th percentile; notably above typical state volume), while 99214 has 18.6K claims and $1.7M revenue (17.2%) and ranks #17 of 532 (97th percentile; notably above typical state volume). Together these figures point to large, established outpatient panels and substantial continuing-care demand.

Emergency department services also drive significant Medicaid revenue: 99284 accounts for $2.2M (22.3%) with 20.4K claims and ranks #10 of 75 in-state (88th percentile; typical, unremarkable volume), and 99283 contributes $1.1M (11.5%) with 17.3K claims (rank #16 of 88, 83rd percentile). The mix of moderate- and low-acuity ED E/M codes suggests the provider operates a high-throughput ED with a range of acuity but without an outsized share of the highest-acuity code 99285.

Preventive and pediatric services plus immunizations are meaningful secondary lines: 90460 (7.9K claims, $337.8K, 3.4%) and 90461 (3.9K claims, $23.2K) and well‑visit codes 99391/99392 (2.9K and 2.6K claims, ~$306K and ~$304.6K respectively) indicate active vaccination and routine preventive workflows, supporting a family medicine taxonomy and a pediatric/wellness component to the practice.

Clinical support services such as ECGs and echocardiography appear frequently: 93010 has 12.3K claims and $86.2K revenue (0.9%) and ranks #7 of 44 in-state (86th percentile), while 93306 (748 claims, $32.9K) also appears on the top list. These volumes imply in-office diagnostic capacity that complements both outpatient and ED encounters.

Competitive standing is strong in-state for office E/M: multiple office visit codes (99213 and 99214) are in the 97th percentile and labeled "notably above typical state volume," identifying the provider as a major state-level participant for routine E/M. By contrast, several ED codes and other services are in mid-to-upper percentiles described as "typical, unremarkable volume," indicating a competitive but not dominant position across all service lines.

The provider has a long-tenure NPI (enumerated 2010-08-25 (~16 years ago)), and the combination of sustained high claim counts across core E/M and ED codes together with the $9.9M Medicaid revenue suggests operational stability focused on primary care, preventive services, and emergency department throughput. The concentrated revenue reliance on the top three codes (66.4%) highlights an exposure to changes in E/M reimbursement or Medicaid policy that would materially affect overall revenue.

Medicaid: Complete Services Breakdown

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

81 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…	33,440	$80	$2.6M
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.	20,410	$110	$2.2M
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…	18,560	$90	$1.7M
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.	17,300	$70	$1.1M
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.	7,860	$40	$337.8K
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…	2,860	$110	$306K
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…	2,560	$120	$304.6K
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.	1,850	$130	$232.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,110	$120	$134.2K
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…	800	$150	$119.8K

Showing 1–10 of 81

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Scl Health Medical Group-butte LLC — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

81 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	30	60	2,160	$80	$526.7K
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.	10	80	2,770	$60	$471K
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.	16	90	2,330	$40	$281.3K
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…	17	530	580	$70	$224.6K
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…	15	520	730	$40	$196.4K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	874	1,200	750	$80	$143.2K
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	50	1,150	$50	$119.8K
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…	11	70	420	$80	$111.7K
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…	10	70	310	$90	$107.1K
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.	5	50	620	$40	$101K

Showing 1–10 of 81

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Riverside Radiology And Interventional Associates Inc	OH	Diagnostic Radiology Physician	$0	$30.3M
Douglas Debenham	IN	Radiation Oncology Physician	$1.8M	$0
Shawn Ahmed	MN	Diagnostic Radiology Physician	$505K	$0
Zachary Scheer	MT	Orthopaedic Surgery Physician	$379.2K	$0
William Vancise	OH	Radiation Oncology Physician	$317.7K	$0
St. James Healthcare	MT	Clinical Medical Laboratory	$0	$316.9K
Jeffrey Harris	GA	Obstetrics & Gynecology Physician	$4.5K	$282.4K
Elizabeth Lowney	MT	Mental Health Counselor	$0	$267.6K
Anastasios Saliaris	MT	Clinical Cardiac Electrophysiology Physician	$240.7K	$0
Casey Cotton	MT	Diagnostic Radiology Physician	$225.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bsw, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$20.4M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$14.6M
State Of Montana	MT	Substance Abuse Rehabilitation Facility	$0	$12.7M
Butte Public Schools	MT	Local Education Agency (LEA)	$0	$6.9M
Community, Counseling & Correctional Services, Inc.	MT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$3.8M
Butte School District #1	MT	Mental Health Counselor	$0	$3.8M
Ryan Todorovich	MT	General Practice Dentistry	$0	$3.1M
Lindsey Todorovich	MT	General Practice Dentistry	$0	$2.9M
Silver Bow County Developmental Disabilities Council, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$2.2M
Big Sky Senior Living	MT	Assisted Living Facility	$0	$2.1M

Scl Health Medical Group-butte LLC — Billing Profile & Reimbursement Data

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Scl Health Medical Group-butte LLC — 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