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 District of Columbia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to District of Columbia 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. District of Columbia (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.

Medstar Washington Hospital Center (NPI 1548378235)

Key Findings

Field	Value
Entity Type	Organization
Organization	Medstar Washington Hospital Center
Address	110 Irving St Nw
City	Washington
State	DC
ZIP	20010
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 25, 2006

Payer Source	Total Paid
Medicaid	$239M
Medicare	$0

This provider is effectively a single‑payer Medicaid hospital: there is no Medicare billing on file while total Medicaid revenue is $239M. The absence of Medicare activity means analyses of payer mix and utilization should treat Medicaid as the dominant — and for practical purposes sole — public payer represented in these claims data.

Revenue is concentrated in a small set of outpatient and ED evaluation/management services: G0463 generated $16.3M (9.8%), 99213 generated $15.7M (9.4%), and 99283 generated $15.5M (9.3%); these three codes together account for 28.6% of the provider’s total Medicaid revenue. This concentration indicates a reliance on clinic/ambulatory assessment and emergency department throughput to drive Medicaid gross revenue.

The top codes describe an operational profile centered on high-volume hospital outpatient clinics and emergency care. G0463 (hospital outpatient clinic visits) and multiple E/M codes (99213, 99214, 99215 and ED codes 99282–99285) point to heavy ambulatory and ED utilization, while frequent administration codes (96361, 96360) show sizable IV fluid/infusion activity, consistent with an acute care hospital managing both walk-in and admitted patients.

Service lines beyond basic E/M appear robust and vertically integrated: oncology and advanced therapeutics are material revenue drivers — J9271 (pembrolizumab) accounts for $8M and is the only in‑state reporter of that code (no state peer volume comparison available), while radiation delivery (77412, $2.3M) and PET/CT (78815, $2M) are also present. High-volume imaging (70450, $4.7M; 74177, $2.9M) and diagnostic endoscopy (43239, $3.4M; 45380/45385 combined) further support a full‑service tertiary care footprint.

The provider is a dominant in‑state performer for multiple service lines: G0463 ranks #1 of 11 providers in‑state (100th percentile) and infusion/IV codes 96361 and 96360 both rank #1 in‑state (100th percentile), while several procedure and imaging codes (43239, 45385, 78815, 59025) also rank #1 of their peer sets. These rankings indicate the hospital functions as a major referral center in the state for outpatient clinic visits, infusion therapies, certain endoscopy services, and advanced imaging.

Ambulatory E/M volumes are extreme outliers relative to state peers: 99213 (73.4K claims) ranks #7 of 316 providers (98th percentile; extreme outlier, far above typical state volume), 99214 (56.7K claims) ranks #7 of 305 (98th percentile; extreme outlier, far above typical state volume), and 99215 (55.8K claims) ranks #2 of 121 (99th percentile; extreme outlier, far above typical state volume). These patterns suggest unusually large established‑patient clinic throughput and/or centralized outpatient services compared with other in‑state providers.

Emergency department codes show very large absolute volumes but generally fall in high‑percentile yet not exceptional peer positions: 99283 ($15.5M) ranks #5 of 38 (89th percentile; typical, unremarkable volume), 99284 ($14.2M) ranks #6 of 34 (85th percentile; typical, unremarkable volume), and 99285 ($9.4M) ranks #4 of 26 (88th percentile; typical, unremarkable volume). In practice this means the ED is a key revenue engine by volume, but its case mix and billed levels are broadly consistent with other busy acute care hospitals in the state.

The provider has an established operating history: NPI enumeration date is 2006-08-25 (~20 years ago), indicating sustained presence and likely well‑developed referral relationships and operational infrastructure that align with the high volumes seen across clinic, ED, infusion, imaging, and specialty oncology services. Analysts should consider this tenure when assessing capacity, regional market role, and contracting leverage tied to the observed Medicaid activity.

Medicaid: Complete Services Breakdown

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

640 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	149,570	$110	$16.3M
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…	73,450	$210	$15.7M
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.	72,320	$220	$15.5M
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.	61,390	$230	$14.2M
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.	27,060	$520	$14M
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…	56,680	$200	$11.1M
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…	55,820	$190	$10.8M
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.	47,180	$200	$9.4M
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,…	48,510	$180	$8.6M
J9271	Injection, pembrolizumab, 1 mg	1,110	$7,190	$8M

Showing 1–10 of 640

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. District of Columbia Distribution

Medstar Washington Hospital Center — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — District of Columbia

Full comparison — all codes billed, vs. District of Columbia median

640 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	1	10	1,110	$7,190	$8M
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.	1	10	5,630	$540	$4.4M
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.	4	30	4,480	$140	$3.5M
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.	6	30	540	$140	$3.4M
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.	5	40	190	$150	$3.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	1	10	6,080	$100	$2M
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.	5	10	5,170	$170	$1.9M
99281	The provider sees a patient for the lowest level emergency department visit.	3	10	1,890	$220	$1.6M
93798	The provider supervises the patient while the patient exercises and reviews the patient’s diet with him or her. The patient exercises with continuous ECG monitoring.	1	10	5,730	$250	$1.4M
77412	The provider delivers radiation therapy at level 3 complexity. This includes photon therapy delivered to multiple isocenters, photon therapy with active motion management, total skin electron…	1	10	4,190	$330	$1.4M

Showing 1–10 of 640

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Washington Hospital Center Corporation	DC	Psychiatric Hospital	$0	$298.1K
Washington Hospital Center Corp	DC	Psychiatry Physician	$0	$203.2K
Robert Keisling	DC	Psychiatry Physician	$12.8K	$28.6K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital	DC	Children's Hospital	$0	$243.1M
Children's Hospital	DC	Pediatrics Physician	$0	$115.3M
Whc Physician Group LLC	DC	General Practice Physician	$0	$93.8M
Medstar Medical Group Radiology, LLC	DC	Diagnostic Radiology Physician	$0	$17.5M
National Rehabilitation Hospital Inc	DC	Rehabilitation Hospital	$0	$16.9M
Hero Dental Of Washington Dc PC	DC	General Practice Dentistry	$0	$11.7M
Medstar Heart Institute LLC	DC	Surgery Physician	$0	$4.8M
Bio-medical Applications Of Columbia Heights, Inc.	DC	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4.6M
Washington Hospital Center Corp	DC	General Practice Physician	$0	$3.7M
Capital Area Renal Associates, PC	DC	Internal Medicine Physician	$0	$3.6M

Medstar Washington Hospital Center — Billing Profile & Reimbursement Data

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Medstar Washington Hospital 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