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

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

Vhs Childrens Hospital Of Michigan Inc (NPI 1538471800)

Field	Value
Entity Type	Organization
Organization	Vhs Childrens Hospital Of Michigan Inc
Address	3901 Beaubien St
City	Detroit
State	MI
ZIP	48201
Taxonomy	Children's Hospital
NPI Enumerated	July 2, 2010

Payer Source	Total Paid
Medicaid	$180.4M
Medicare	$0

Key Findings

This facility reports $180.4M in lifetime Medicaid revenue and has no Medicare billing on file, making its Medicare footprint effectively nil and its financial exposure concentrated in Medicaid. Its NPI was enumerated 2010-07-02 (~16 years ago), indicating a sustained operational presence in the market.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 50.9% of the provider’s total Medicaid revenue, driven primarily by 99283 ($27.8M, 20.0%), G0463 ($26M, 18.7%), and 99285 ($17M, 12.2%). That concentration signals that a small set of high-volume emergency department and hospital outpatient clinic services disproportionately drive overall Medicaid receipts.

The code mix shows a heavy emergency-department orientation. 99283 appears at very large volume (219.2K claims, $127 avg paid/claim, $27.8M revenue) and ranks #2 of 447 in-state (100th percentile; extreme outlier), while 99285 ($17M, 12.2%) and 99284 ($11.5M, 8.3%) are also material; together this pattern indicates the organization operates a high-volume pediatric ED that is a core revenue center.

Hospital outpatient and observation services are also central to the business model: G0463 (456.2K claims, $57 avg paid/claim, $26M revenue, 18.7%) ranks #3 in-state (99th percentile; notably above typical), and G0378 (20.8K claims, $485 avg paid/claim, $10.1M revenue, 7.3%) ranks #8 (93th percentile; notably above typical). These codes point to substantial hospital-based clinic throughput and use of observation stays alongside ED care.

Pediatric surgical and ENT procedures are prominent specialties for this provider. 42820 (tonsil/adenoid removal) generated $11.6M (8.3%) and ranks #1 of 50 in-state (100th percentile; extreme outlier), and 42830 (initial adenoidectomy) recorded $1.2M (0.9%) and also ranks #1 (100th percentile); tympanostomy 69436 is likewise above typical state volume. This clustering of high-ranking pediatric ENT procedures signals a regional surgical referral role for children.

Cardiac imaging and advanced diagnostics appear as meaningful ancillary service lines: 93306 ($2.8M, 2.0%) and 93303 ($2.2M, 1.5%) both place above typical state volume (95th and 90th percentiles respectively), while MRI codes 70553 and 70551 and sleep testing 95810 are also elevated. Together these codes indicate institutional capacity for pediatric cardiology, neuroimaging, and sleep medicine supporting the clinical mix.

Preventive, developmental, and newborn services are significant and unusually large relative to peers: preventive visits 99391 and 99392 each generated roughly $1.4–$1.5M and rank in the 99th percentile (described as extreme outliers), while newborn hearing/OTO screening 92587 and speech/hearing 92507 show notably above typical volumes. This suggests robust ambulatory well-child, developmental, and newborn screening activity embedded in the provider’s Medicaid case mix.

State-level competitive standing is strong and concentrated: multiple codes are listed as extreme outliers or top-ranked in-state (for example, 99283 #2 of 447 100th percentile; 99281 #1 of 145 100th percentile; 42820 and 42830 both #1 in their cohorts). While several high-revenue codes are dominant in-state, some large codes such as 99285 rank only at the 90th percentile (typical, unremarkable), so the provider is a major pediatric hub for certain services but exhibits variability across specific service lines.

Medicaid: Complete Services Breakdown

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

612 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	219,210	$130	$27.8M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	456,200	$60	$26M
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.	39,810	$430	$17M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	4,380	$2,650	$11.6M
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.	52,320	$220	$11.5M
G0378	Hospital observation service, per hour	20,850	$490	$10.1M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	3,670	$1,100	$4M
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	2,570	$1,100	$2.8M
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…	10,570	$260	$2.8M
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…	8,580	$250	$2.2M

Showing 1–10 of 612

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Vhs Childrens Hospital Of Michigan Inc — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

612 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	3	150	5,330	$50	$2.8M
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.	42	400	1,510	$190	$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.	35	480	1,350	$110	$1.7M
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	3	10	440	$970	$1.4M
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.	2	450	1,540	$90	$1.3M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	47	150	7,610	$90	$1.2M
G0378	Hospital observation service, per hour	8	100	2,820	$180	$1.1M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	8	10	290	$1,440	$1M
95715	The patient undergoes electroencephalography, a study of the electrical activity of the brain, lasting 12 to 26 hours with intermittent monitoring and maintenance. A video recording is made, and an…	3	10	2,420	$360	$931.7K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	1	50	150	$1,300	$889.5K

Showing 1–10 of 612

Nearby Providers

Other providers in the same ZIP code as Vhs Childrens Hospital Of Michigan Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Pediatricians	MI	Pediatrics Physician	$0	$106.9M
University Physician Group	MI	Internal Medicine Physician	$0	$87.4M
Vhs Harper-hutzel Hospital Inc	MI	General Acute Care Hospital	$0	$76.6M
The Children's Center Of Wayne Co., Inc.	MI	Community/Behavioral Health Agency	$0	$74.3M
Vhs Detroit Receiving Hospital Inc	MI	General Acute Care Hospital	$0	$60.6M
Medical Center Emergency Services	MI	Emergency Medical Services (Emergency Medicine) Physician	$0	$44.1M
Barbara Ann Karmanos Cancer Hospital	MI	General Acute Care Hospital	$0	$42.5M
Detroit Central City Community Mental Health Inc.	MI	Federally Qualified Health Center (FQHC)	$0	$29.2M
Vhs University Laboratories Inc	MI	Clinical Medical Laboratory	$677.7K	$26.3M
Vhs Rehabilitation Institute Of Michigan Inc	MI	Rehabilitation Hospital	$0	$24.1M

Vhs Childrens Hospital Of Michigan Inc — Billing Profile & Reimbursement Data

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Vhs Childrens Hospital Of Michigan Inc — 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