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

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

Children's Hospital Medical Center (NPI 1548212988)

Field	Value
Entity Type	Organization
Organization	Children's Hospital Medical Center
Address	3333 Burnet Ave
City	Cincinnati
State	OH
ZIP	45229
Taxonomy	Children's Hospital
NPI Enumerated	May 16, 2006

Payer Source	Total Paid
Medicaid	$386.8M
Medicare	$0

Key Findings

This entity is effectively single-payer in the Medicare/Medicaid mix: there is no Medicare billing on file and the provider reports $386.8M in lifetime Medicaid revenue, so operational scale and payer risk are concentrated in Medicaid. Analysts should treat Medicaid trends here as the primary driver of revenue performance and market behavior.

Revenue concentration is high: the top 3 Medicaid codes by revenue account for 41.0% of this provider's total Medicaid revenue, with the single largest code 99213 contributing $61.9M (573.2K claims, $108 avg paid/claim, 25.5% of Medicaid revenue). That concentration means a relatively small set of ambulatory E/M services dominates overall Medicaid receipts.

The code mix indicates a large pediatric ambulatory and emergency practice with substantial preventive care throughput: high-volume evaluation & management codes 99213 (573.2K claims), 99212 (163.5K claims), 99214 (141.9K claims) and preventive codes 99391/99392/99393 collectively show both routine well-child visits and frequent established-patient encounters. Emergency department visit codes 99283, 99282, 99284 and 99285 also generate material revenue, signaling integrated ED and outpatient workflows common to a children's hospital.

The provider is a statewide leader for several pediatric surgical and procedure codes, indicating significant operative capacity in ENT and ambulatory surgery. Notably, 69436 (tympanostomy) generated $11.2M and ranks #1 of 79 providers in-state (100th percentile; extreme outlier), and 42820 (tonsil/adenoid removal) generated $5.7M and ranks #1 of 40 providers in-state (100th percentile; extreme outlier), pointing to high-volume surgical programs.

Behavioral health, developmental screening, and allied therapies are large service lines: 96127 ($11.0M, 94.7K claims) and 96110 ($10.9M, 43.7K claims) rank #2 in-state (100th percentile; extreme outlier), while psychotherapy codes 90834 and 90837 and therapeutic day/partial hospitalization codes (H2020, S0201) also appear in the top code list. These volumes and ranks indicate a substantial investment in pediatric mental health, developmental assessment, speech therapy (92507, $5.9M) and rehabilitative services (97110, 97530).

Competitive standing across Medicaid is dominant for many key pediatric codes: 99213 ranks #6 of 5077 providers in-state (100th percentile; extreme outlier), 99212 ranks #2 of 1608 (100th percentile; extreme outlier), and multiple procedure codes occupy top-1 or top-2 statewide positions. Where percentile labels indicate "notably above typical" or "typical, unremarkable," the provider still shows above-average engagement (for example, 99284 is 86th percentile and 99285 is 80th percentile), meaning the hospital is a major statewide hub but not uniformly extreme across every code.

The operation appears volume-driven on lower-acuity ambulatory and therapy encounters: very large claim counts for outpatient codes—99213 (573.2K claims), 97530 (102.9K claims), 99283 (140K claims)—combined with moderate per-claim payments (e.g., $108 for 99213, $71 for 97530) suggest margins are sensitive to visit volumes and care mix. This pattern is consistent with a children's hospital whose Medicaid revenue derives from high-throughput clinic, ED, therapy and screening services rather than high-priced single procedures.

The provider has long-tenure NPI registration (enumerated 2006-05-16, ~20 years ago), which together with its statewide top ranks and large Medicaid revenue base suggests an entrenched role in the Ohio pediatric Medicaid market; strategic or reimbursement changes in Medicaid would therefore have outsized impact on this organization's financials.

Medicaid: Complete Services Breakdown

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

918 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…	573,210	$110	$61.9M
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.	140,050	$140	$20.2M
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,…	163,470	$110	$17.5M
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…	141,940	$110	$14.9M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	9,910	$1,130	$11.2M
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	94,710	$120	$11M
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	43,710	$250	$10.9M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	64,610	$130	$8.1M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	102,910	$70	$7.3M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	46,540	$140	$6.3M

Showing 1–10 of 918

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Children's Hospital Medical Center — 20 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

918 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	90	150	4,030	$100	$5.9M
81226	The lab analyst performs the technical lab test to detect the presence of common changes in the gene for cytochrome P450, family 2, subfamily D, polypeptide 6, also known as CYP2D6.	3	10	80	$40	$2.7M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	71	170	4,660	$300	$2.6M
81225	The lab analyst performs the technical lab test to detect the presence of common changes in the gene for cytochrome P450, family 2, subfamily C, polypeptide 19, also known as CYP2C19.	3	10	90	$30	$2M
81479	Use 81479 to report a molecular pathology procedure that does not have a specific code.	2	10	760	$50	$2M
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.	14	480	4,510	$90	$1.8M
H2019	Therapeutic behavioral services, per 15 minutes	128	840	240	$90	$1.8M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	3	10	890	$1,920	$1.7M
J3380	Injection, vedolizumab, intravenous, 1 mg	4	10	240	$5,260	$1.5M
H2020	Therapeutic behavioral services, per diem	30	310	1,190	$150	$1.5M

Showing 1–10 of 918

Related Providers

Other providers that share a Tax Identification Number (TIN) with Children's Hospital Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Of Cincinnati Medical Center, LLC	OH	General Acute Care Hospital	$0	$176.6M
Children's Hospital Medical Center	OH	Pediatrics Physician	$0	$91.2M
Children's Hospital Medical Center	OH	Home Infusion Therapy Pharmacy	$0	$57M
Children's Hospital Medical Center	OH	Durable Medical Equipment & Medical Supplies	$0	$51.1M
Children's Hospital Medical Center	OH	Home Health Agency	$0	$19.2M
Children's Hospital Medical Center	OH	Pediatric Dentistry	$0	$11.6M
Robert Sisk	OH	Ophthalmology Physician	$2.5M	$0
William Hansen	OH	Counseling Psychologist	$112.8K	$194.9K
Roxana Rivera	OH	Ophthalmology Physician	$216K	$0
Mehran Attari	OH	Clinical Cardiac Electrophysiology Physician	$207K	$0

Nearby Providers

Other providers in the same ZIP code as Children's Hospital Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Central Clinic Outpatient Services	OH	Mental Health Counselor	$0	$30.8M
Ohio First Home Healthcare Inc.	OH	Home Health Aide	$0	$14.2M
Laboratory Corporation Of America Holdings	OH	Clinical Medical Laboratory	$619.7K	$4.9M
Terri Mcmillan	OH	Allergy Physician	$67.8K	$0
Ann Orlet	OH	Certified Registered Nurse Anesthetist	$52.4K	$0
Rebecca Soward	OH	Physician Assistant	$37.8K	$0
Jennifer Estes	OH	Certified Registered Nurse Anesthetist	$36.4K	$0
Howard Melvin	OH	Ophthalmology Physician	$31K	$2.8K
Jane Smith	OH	Pediatric Nurse Practitioner	$24.1K	$0
Christopher Cates	OH	Pulmonary Disease Physician	$20.4K	$0

Children's Hospital Medical Center — Billing Profile & Reimbursement Data

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Children's Hospital Medical Center — 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