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 - Billings LLC (NPI 1508289703)

Key Findings

Field	Value
Entity Type	Organization
Organization	Scl Health Medical Group - Billings LLC
Address	1233 N 30th St
City	Billings
State	MT
ZIP	59101
Taxonomy	Clinic/Center
NPI Enumerated	January 24, 2014

Payer Source	Total Paid
Medicaid	$32.2M
Medicare	$0

This provider has no Medicare billing on file and reports total Medicaid revenue of $32.2M, making its public-payer footprint effectively single-payer Medicaid. NPI was enumerated on 2014-01-24 (~12 years ago), indicating the entity has been registered and operating in the federal NPI system for about a decade.

Revenue concentration is high: the top three Medicaid codes account for 72.2% of this provider's total Medicaid revenue, led by 99214 ($11.9M, 39.0%), 99213 ($7.8M, 25.6%), and 99284 ($2.3M, 7.5%). This shows a heavy reliance on a very small set of codes for most Medicaid dollars.

The service mix is dominated by evaluation-and-management activity: 99214 and 99213 are the two largest revenue drivers, while emergency department E/M codes (99284, 99285) also contribute materially. Combined with the Clinic/Center taxonomy, the pattern is consistent with a high-volume outpatient clinic that also handles acute/ED encounters.

Operational scale is evident in claim counts and average paid amounts: 99214 appears on 125.1K claims with an avg paid/claim of $95 and 99213 on 110.1K claims with an avg paid/claim of $71, reflecting very high throughput of established-patient visits. Those volumes, together with their revenue shares, indicate day-to-day operations are driven by frequent office visits.

State-level competitive standing is strong for core E/M codes: 99214 ranks #1 of 532 providers in-state (100th percentile; extreme outlier) and 99213 ranks #3 of 523 providers in-state (100th percentile; extreme outlier), signaling dominant statewide volume for these office-visit services. By comparison, 99284 ranks #14 of 75 (82th percentile; typical, unremarkable volume), so ED activity is present but not uniquely dominant in the state.

Beyond core E/M, the provider shows top-in-state placement on several other codes, indicating breadth of services: 99215 (2.6% of Medicaid revenue) ranks #3 of 156 (99th percentile; extreme outlier), 99203 (2.0%) ranks #2 of 190 (99th percentile; extreme outlier), 99205 (0.8%) ranks #2 of 67 (98th percentile; extreme outlier), and 90960 ranks #1 of 9 (100th percentile; notably above typical). These rankings point to meaningful volume in higher-complexity visits, new-patient encounters, and ESRD monthly management.

Because 72.2% of Medicaid revenue is concentrated in a small set of E/M codes and those codes have very high claim volumes, this provider's Medicaid revenue is sensitive to reimbursement, policy, or utilization-management changes affecting office-visit and ED E/M payments. Payers and analysts should prioritize monitoring utilization and payment edits for 99214/99213 (and related E/M codes) when assessing financial or network risk for this entity.

Medicaid: Complete Services Breakdown

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

139 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…	125,130	$100	$11.9M
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…	110,150	$70	$7.8M
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.	18,050	$130	$2.3M
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.	11,320	$160	$1.9M
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.	17,110	$80	$1.3M
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…	6,090	$130	$785.6K
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…	6,330	$100	$619.9K
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…	7,100	$80	$596.3K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	1,980	$180	$362K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	4,060	$90	$349.2K

Showing 1–10 of 139

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 - Billings LLC — 11 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

139 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.	10	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.	14	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.	17	90	2,330	$40	$281.3K
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…	14	30	770	$60	$233.3K
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…	1	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…	3	520	730	$40	$196.4K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	9	30	640	$90	$188.1K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	3	20	970	$100	$148K
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…	49	1,200	750	$80	$143.2K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	4	10	280	$200	$139.4K

Showing 1–10 of 139

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Scl Health Montana	MT	General Acute Care Hospital	$0	$13.5M
Scl Health Montana	MT	Durable Medical Equipment & Medical Supplies	$0	$2.7M
Douglas Debenham	IN	Radiation Oncology Physician	$1.8M	$0
Eric Maranda	MT	Dermatology Physician	$1.1M	$0
Scl Health Montana	MT	Emergency Care Clinic/Center	$0	$867.8K
Zachary Arthurs	SC	Vascular Surgery Physician	$641.3K	$0
Mohamad El-zaru	MA	Cardiovascular Disease Physician	$543.5K	$0
Joseph Apostol	MT	Cardiovascular Disease Physician	$461.8K	$0
Scl Health Montana	MT	Oncology Clinic/Center	$0	$448.6K
Jared Heaton	UT	MOHS-Micrographic Surgery Physician	$447.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Billings Clinic	MT	General Practice Physician	$0	$53.8M
Rimrock Foundation	MT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$44.9M
Residential Support Services	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$30.6M
Billings Public School District 2	MT	Local Education Agency (LEA)	$0	$19.2M
South Central Montana Regional Mental Health Center	MT	Clinic/Center	$0	$16.6M
Billings Clinic	MT	Emergency Care Clinic/Center	$0	$15.7M
Community Solutions Incorporated	MT	Clinical Medical Laboratory	$0	$14.1M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$10.8M
American Medical Response Ambulance Service Inc	MT	Ambulance	$2.1M	$6.7M
Yellowstone Pathology Institute, Inc.	MT	Clinical Medical Laboratory	$777.4K	$4.4M

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

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Scl Health Medical Group - Billings 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