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

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

Saint Joseph Health System, Inc. (NPI 1508918533)

Saint Joseph Health System, Inc. is a rural health clinic/center provider located in London, Kentucky. This profile covers 0 Medicare and 47 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	Saint Joseph Health System, Inc.
Address	378 Thompson Poynter Rd
City	London
State	KY
ZIP	40741
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	January 18, 2007

Payer Source	Total Paid
Medicaid	$6.9M
Medicare	$0

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

47 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…	72,130	$40	$2.8M
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…	10,040	$70	$662.9K
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…	7,160	$80	$544.5K
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…	8,460	$60	$524.2K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	20,660	$20	$351.2K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	7,160	$40	$300.7K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	21,320	$10	$298.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,800	$80	$284.9K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	14,220	$20	$213.2K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	3,130	$50	$150.4K

Showing 1–10 of 47

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Saint Joseph Health System, Inc. — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

47 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	72	3,340	1,020	$30	$296K
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…	251	2,460	580	$40	$245K
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…	17	230	720	$60	$180.1K
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…	22	260	540	$70	$176.6K
94640	The provider administers oxygen under pressure or not under pressure to open obstructed air passages. He uses any of the listed devices to treat a patient with an acute obstruction of the airway that…	156	170	590	$40	$84.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	22	320	180	$70	$79.9K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	13	210	230	$40	$79.7K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	252	870	480	$20	$61.8K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	207	1,450	270	$30	$61K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	180	400	360	$20	$59.3K

Showing 1–10 of 47

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Joseph Health System, Inc	KY	Rural Acute Care Hospital	$0	$83.7M
Forever Care Dba Independent Opportunities	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$79M
Brock Medical, LLC	KY	Nurse Practitioner	$0	$63.5M
Recover Together, Inc.	KY	Adult Mental Health Clinic/Center	$0	$36.6M
Pinnacle Treatment Centers Ky-i, LLC	KY	Substance Abuse Rehabilitation Facility	$0	$33.5M
London Women's Care, LLC	KY	Obstetrics & Gynecology Physician	$0	$16M
Inspired Living	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$12M
Rrj Solutions, LLC	KY	Community/Behavioral Health Agency	$0	$8.6M
Cherished Care LLC	KY	Internal Medicine Physician	$0	$7M
Fuse Medical	KY	Nurse Practitioner	$0	$7M

Saint Joseph Health System, Inc. — 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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