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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

Prisma Health Tuomey (NPI 1548625593)

Prisma Health Tuomey is a emergency medicine physician provider located in Sumter, South Carolina. This profile covers 0 Medicare and 14 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	Prisma Health Tuomey
Address	129 N Washington St
City	Sumter
State	SC
ZIP	29150
Taxonomy	Emergency Medicine Physician
NPI Enumerated	December 17, 2015

Payer Source	Total Paid
Medicaid	$6.8M
Medicare	$0

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	33,950	$80	$2.7M
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.	25,620	$100	$2.6M
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.	32,100	$40	$1.4M
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	13,990	$10	$69.9K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	380	$80	$29.6K
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…	480	$60	$28.2K
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…	300	$20	$7.2K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	70	$90	$5.7K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	150	$30	$5K
93042	The provider interprets a recording of the electrical conduction of the heart to examine any abnormality in its functioning using a maximum of three leads, wires that connect the recording device to…	1,560	$1	$3.1K

Showing 1–10 of 14

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Carolina Distribution

Prisma Health Tuomey — 1 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. South Carolina median

14 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	34	340	110	$40	$450.5K
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.	19	350	100	$50	$446.9K
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.	14	200	1,680	$50	$443.2K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	57	60	350	$190	$230.8K
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…	87	140	690	$80	$153.6K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	30	70	220	$80	$63.9K
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…	39	120	150	$60	$49.4K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	58	90	130	$70	$29.5K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	17	160	160	$1	$21.8K
99217	N/A	11	10	140	$40	$14.8K

Showing 1–10 of 14

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health University Medical Group	SC	Family Medicine Physician	$0	$171.7M
Prisma Health Medical Group-midlands	SC	Multi-Specialty Clinic/Center	$0	$77.6M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$74.6M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$68.3M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$28.1M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$11.8M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$7.4M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$6.9M
Prisma Health-midlands	SC	Emergency Medicine Physician	$0	$6.8M
Prisma Health-midlands	SC	Home Health Agency	$0	$4.6M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sumter Pediatrics, P.A.	SC	Pediatrics Physician	$0	$24.4M
Tandem Health Sc	SC	Federally Qualified Health Center (FQHC)	$0	$17.3M
Colonial Family Practice, LLC	SC	Family Medicine Physician	$0	$9.5M
Tandem Health Sc	SC	Federally Qualified Health Center (FQHC)	$0	$7.8M
Wesmark Dental Health Center	SC	General Practice Dentistry	$0	$6.3M
Addus Healthcare (south Carolina), Inc.	SC	In Home Supportive Care Agency	$0	$5.5M
Carolina Children's Dentistry, LLC	SC	Pediatric Dentistry	$0	$5.2M
Sumter School District	SC	Local Education Agency (LEA)	$0	$4.2M
Kool Smiles, PC	SC	General Practice Dentistry	$0	$4.2M
Sumter County Ems	SC	Ambulance	$971.3K	$3M

Prisma Health Tuomey — 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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