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

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

Lahey Clinic Hospital, Inc. (NPI 1558392563)

Field	Value
Entity Type	Organization
Organization	Lahey Clinic Hospital, Inc.
Address	41 Mall Rd
City	Burlington
State	MA
ZIP	01805
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 6, 2006

Payer Source	Total Paid
Medicaid	$112.9M
Medicare	$0

Key Findings

Provider is effectively single‑payer in the available dataset: there is no Medicare billing on file and all reported program revenue is from Medicaid, totaling $112.9M. This concentration makes Medicaid performance the primary driver of the provider's revenue profile and competitive position in-state.

A small set of evaluation-and-management codes drives a large share of Medicaid revenue: 99214 ($12M, 15.8%), 99213 ($7M, 9.2%), and 99285 ($6.3M, 8.4%) together account for 33.4% of the provider's total Medicaid revenue. This concentration indicates that office/outpatient visits and high-acuity ED E/M visits are principal revenue engines for the organization.

The code mix and claim volumes point to a large acute-care hospital with heavy outpatient and emergency throughput: 99214 has 90.8K claims, G0463 has 198.2K claims and $5.4M revenue, and ED codes 99285/99284/99283 together appear repeatedly in the top revenue list. High counts of lower- and mid-level E/M codes (99211, 99212, 99213, 99214, 99215) plus G0463 suggest substantial ambulatory clinic volume co-located or operated by the hospital.

Competitive standing in Massachusetts is strong on core outpatient E/M volumes: 99214 ranks #28 of 5039 providers in-state (99th percentile; extreme outlier) and 99213 ranks #40 of 5303 (99th percentile; extreme outlier), signaling a market position well above typical state peers for those visit types. Several other codes also rank highly—99396 ranks #8 of 296 (98th percentile; extreme outlier) and J0585 ranks #1 of 40 (100th percentile; notably above typical)—supporting a pattern of statewide dominance in multiple ambulatory and specialized services.

Emergency department activity is substantial in absolute terms but more typical versus specialist ED providers: 99285 reports $6.3M revenue and ranks #36 of 521 providers in-state (93rd percentile; typical, unremarkable volume), while 99284 and 99283 sit in similar percentile ranges. This suggests the hospital handles a high volume of acute care cases but does not appear anomalous among other ED-capable hospitals on a rank-for-rank basis.

The provider maintains a broad set of procedural and specialty services that complement its E/M-driven revenue: notable procedure and imaging codes include 45385, 43239, 45380 (colonoscopy/upper endoscopy series), advanced imaging codes 78815, 70553, 74177, and oncology infusion code 96413. The presence of 96361 (IV fluids) and high-paid procedural codes indicates integrated inpatient/outpatient procedural capacity that diversifies Medicaid revenue beyond basic clinic visits.

Ambulatory throughput is an operational signature: G0463 (hospital outpatient clinic visit) produced $5.4M on 198.2K claims and the provider posts large claim counts for multiple office-visit levels (e.g., 99214 90.8K claims, 99213 57.7K claims). These volumes point to high patient flow and clinic capacity that likely supports ancillary services and procedural referrals within the hospital system.

The provider has an established market presence with long tenure: the NPI was enumerated on 2006-07-06 (~20 years ago), and sustained high Medicaid revenue ($112.9M) together with multiple top-state rankings indicate a stable, well-entrenched Medicaid provider in Massachusetts rather than a new entrant or low-volume facility.

Medicaid: Complete Services Breakdown

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

592 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	90,800	$130	$12M
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…	57,710	$120	$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.	39,730	$160	$6.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	198,210	$30	$5.4M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	30,130	$160	$4.7M
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…	35,730	$130	$4.6M
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.	13,780	$320	$4.4M
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,…	33,620	$120	$4.1M
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.	23,960	$150	$3.5M
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.	21,450	$140	$3M

Showing 1–10 of 592

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Lahey Clinic Hospital, Inc. — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

592 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	29	90	7,560	$350	$4.2M
S9485	Crisis intervention mental health services, per diem	83	110	1,250	$540	$3.2M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	10	10	1,380	$1,380	$2.7M
J2357	Injection, omalizumab, 5 mg	10	10	1,540	$850	$1.6M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	18	50	1,870	$210	$1.4M
G0378	Hospital observation service, per hour	27	70	7,250	$100	$1.3M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	39	80	4,380	$140	$1.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	9	110	5,660	$30	$1.1M
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.	36	520	120	$130	$1M
96366	The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease.	40	60	1,750	$260	$907.4K

Showing 1–10 of 592

Related Providers

Other providers that share a Tax Identification Number (TIN) with Lahey Clinic Hospital, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Infinite Health Collaborative, PA	MN	Orthopaedic Surgery Physician	$0	$19.4M
Summit Orthopedics, Ltd	MN	Orthopaedic Surgery Physician	$0	$6.7M
Lahey Clinic, Inc.	MA	Internal Medicine Physician	$0	$5.7M
Lahey Clinic Hospital Inc	MA	Ambulance	$433.4K	$72.9K
Merdod Ghafouri	VA	Cardiovascular Disease Physician	$504.4K	$0
Sou-pan Wu	MN	Rheumatology Physician	$357.6K	$0
Peter Bretzman	MN	Vascular & Interventional Radiology Physician	$190.4K	$0
Christopher Meyer	MN	Sports Medicine (Orthopaedic Surgery) Physician	$187.4K	$0
Christopher Pyne	MA	Interventional Cardiology Physician	$176.1K	$4.9K
Robert Knowlan	MN	Orthopaedic Surgery Physician	$158K	$0

Nearby Providers

Other providers in the same ZIP code as Lahey Clinic Hospital, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kendra Klein-mascia	MA	Ophthalmology Physician	$1.4M	$0
David Ramsey	MA	Ophthalmology Physician	$1M	$0
Jeffrey Marx	MA	Ophthalmology Physician	$933.2K	$0
Stephen Lyle	MA	Anatomic Pathology Physician	$852.2K	$40.3K
Naveen Rao	MA	Cornea and External Diseases Specialist Physician	$392.8K	$0
Pauline Reohr	MA	Dermatology Physician	$385.6K	$0
Sherry Emery	MA	Anatomic Pathology & Clinical Pathology Physician	$208.6K	$64.9K
Christopher Wright	MA	Radiation Oncology Physician	$267.5K	$0
Anne Morris	MA	Diagnostic Radiology Physician	$254.1K	$0
Robert Whitmore	MA	Neurological Surgery Physician	$240.6K	$0

Lahey Clinic Hospital, Inc. — Billing Profile & Reimbursement Data

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Lahey Clinic Hospital, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References