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

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

Kentucky Medical Services Foundation (NPI 1558579185)

Kentucky Medical Services Foundation is a pediatrics physician provider located in Lexington, Kentucky. This profile covers 0 Medicare and 67 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	Kentucky Medical Services Foundation
Address	740 S Limestone
City	Lexington
State	KY
ZIP	40536
Taxonomy	Pediatrics Physician
NPI Enumerated	May 18, 2007

Payer Source	Total Paid
Medicaid	$3.3M
Medicare	$0

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

67 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…	27,670	$40	$1M
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…	9,300	$50	$493K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	10,300	$30	$298.6K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	5,200	$50	$280.6K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	3,960	$60	$241.8K
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…	6,430	$30	$167.1K
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…	3,350	$40	$140.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,430	$60	$85.7K
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…	1,150	$70	$80.4K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	1,500	$40	$58.5K

Showing 1–10 of 67

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Kentucky Medical Services Foundation — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

67 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	753	1,270	760	$80	$447.2K
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…	237	3,340	1,020	$30	$296K
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…	231	2,460	580	$40	$245K
90832	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…	405	600	600	$40	$207.8K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	419	470	770	$20	$188.2K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	33	230	720	$60	$180.1K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	44	260	540	$70	$176.6K
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…	65	500	250	$60	$152.8K
D1120	Prophylaxis–child	340	770	500	$50	$127.1K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	31	400	800	$30	$113.3K

Showing 1–10 of 67

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Of Kentucky	KY	General Acute Care Hospital	$0	$716.8M
Kentucky Medical Services Foundation, Inc	KY	Internal Medicine Physician	$0	$110.4M
Union Associated Physicians Clinic, LLC	IN	Family Medicine Physician	$0	$31.1M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Kentucky Medical Services Foundation	KY	Nurse Practitioner	$0	$12.5M
University Of Kentucky	KY	Dentist	$0	$4.3M
Kentucky Medical Services Foundation	KY	Physician Assistant	$0	$3.4M
John Andriulli	NJ	Cardiovascular Disease Physician	$396.7K	$0
Robert Lavey	KY	Radiation Oncology Physician	$384.3K	$0
Falguni Amin-zimmerman	KY	Radiation Oncology Physician	$378.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Romulo Albuquerque	KY	Retina Specialist (Ophthalmology) Physician	$3.8M	$0
Kentucky Medical Services Foundation	KY	Clinical Pathology/Laboratory Medicine Physician	$0	$3M
Jameson Dupree	KY	Ophthalmology Physician	$1.5M	$0
Elena Samoilova	KY	Anatomic Pathology & Clinical Pathology Physician	$110.7K	$974.6K
Sun Yi	KY	Radiation Oncology Physician	$646.6K	$0
Frances Martin	KY	Urology Physician	$532.8K	$0
Andrew Savoie	KY	Physical Medicine & Rehabilitation Physician	$470.2K	$0
Sarah Deraney	KY	Diagnostic Radiology Physician	$302.4K	$0
Samuel Thompson	KY	Internal Medicine Physician	$244.4K	$0
Matthew Luckett	KY	Orthopaedic Surgery Physician	$236.2K	$0

Kentucky Medical Services Foundation — Billing Profile & Reimbursement Data

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Kentucky Medical Services Foundation — 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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