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.

Pediatric And Neonatal Specialists (NPI 1518001437)

Pediatric And Neonatal Specialists is a pediatrics physician provider located in Louisville, Kentucky. This profile covers 0 Medicare and 100 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	Pediatric And Neonatal Specialists
Address	4123 Dutchmans Ln Ste 410
City	Louisville
State	KY
ZIP	40207
Taxonomy	Pediatrics Physician
NPI Enumerated	February 16, 2007

Payer Source	Total Paid
Medicaid	$8.8M
Medicare	$0

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

100 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…	44,950	$30	$1.5M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	16,180	$70	$1.1M
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…	14,900	$70	$1M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	11,270	$80	$878.7K
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…	11,270	$60	$676K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	31,770	$20	$540.1K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	22,690	$20	$385.7K
85027	The lab analyst performs a blood count on the red and white blood cells and platelets also known as thrombocytes. He also determines the hemoglobin, typically by spectrophotometry, and the…	48,020	$10	$336.1K
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,…	11,020	$20	$253.5K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	13,250	$20	$198.7K

Showing 1–10 of 100

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

Pediatric And Neonatal Specialists — 16 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

100 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	96	130	6,080	$40	$449.7K
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…	134	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…	1,189	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…	16	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…	9	260	540	$70	$176.6K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	157	220	2,810	$10	$94.7K
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…	109	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.	3	320	180	$70	$79.9K
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…	613	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,…	52	1,450	270	$30	$61K

Showing 1–10 of 100

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Access Adult Health Day Care Center	KY	Adult Day Care Clinic/Center	$0	$71M
Baptist Healthcare System Inc.	KY	General Acute Care Hospital	$0	$62.4M
Commonwealth Pain Associates, PLLC	KY	Interventional Pain Medicine Physician	$0	$42.2M
Access Adult Health Day Care Center	KY	Adult Day Care Clinic/Center	$0	$32.6M
Gould's Discount Medical LLC	KY	Durable Medical Equipment & Medical Supplies	$0	$32.1M
Path Forward Of Kentucky Inc.	KY	Community/Behavioral Health Agency	$0	$22.1M
Tatyanas Case Management, LLC	KY	Adult Day Care Clinic/Center	$0	$14.2M
Center For Behavioral Health Kentucky LLC	KY	Methadone Clinic	$299.5K	$13.2M
Emergency Medical Associates, Psc	KY	Emergency Medicine Physician	$0	$8M
Hmr Acquisition, Lca	KY	Case Manager/Care Coordinator	$0	$7M

Pediatric And Neonatal Specialists — Billing Profile & Reimbursement Data

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Pediatric And Neonatal Specialists — 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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