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

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

Mercy Hospital Springfield (NPI 1578504056)

Field	Value
Entity Type	Organization
Organization	Mercy Hospital Springfield
Address	1235 E Cherokee St
City	Springfield
State	MO
ZIP	65804
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 8, 2006

Payer Source	Total Paid
Medicaid	$64.5M
Medicare	$0

Key Findings

MER CY HOSPITAL SPRINGFIELD is effectively a single-payer Medicaid provider: there is no Medicare billing on file while lifetime Medicaid revenue totals $64.5M, indicating the facility’s payer exposure and reported inpatient/outpatient activity are concentrated in state Medicaid. This absence of Medicare activity suggests analysts should treat the profile as Medicaid-driven rather than a mixed Medicare/Medicaid hospital case mix.

Revenue concentration on Medicaid is heavy and highly concentrated: the precomputed top three Medicaid codes account for 53.6% of the provider’s total Medicaid revenue, meaning a small set of services generates the majority of the $64.5M reported Medicaid revenue. Analysts should monitor those primary codes for any payment, utilization, or policy changes that could meaningfully impact the provider’s topline.

Y7506 is the single largest Medicaid revenue driver at $21.1M (34.7% of Medicaid revenue) with 82.9K claims and the provider ranks #1 of 98 in-state; the file labels this as an "extreme outlier," so Springfield is a statewide dominant source for that code and any shifts in coverage or reimbursement for Y7506 would disproportionately affect the provider. This prominence suggests a specialized high-volume service or billing concentration tied to that code.

Emergency department services are a major operational focus: combined high-acuity E/M codes 99285 ($6.4M, 20.7K claims, 97th percentile in-state) and other ED levels 99284 and 99283 together represent substantial Medicaid revenue and high visit volumes. The code mix and volumes indicate the hospital operates a busy emergency department handling a broad range of acuity from low to high medical decision making.

High-volume laboratory and outpatient diagnostic work is another clear service line: 85025 (CBC, $4.3M, 75.4K claims, 98th percentile), 80053 (CMP, $3.3M, 62.1K claims, 98th percentile), and PLA and pathology codes (0202U, 88305, 88312) appear in the top 25, indicating large outpatient/lab throughput that supports both ED and surgical volumes. These lab panels and pathology services are consistent with a full-service acute hospital supporting diagnostics at scale.

Surgical/ENT procedural intensity is notable in pediatric ENT and aerodigestive interventions: 42820 (tonsillectomy/adenoidectomy, $2.7M, 950 claims, ranks #2 in-state) and 69436 (tympanostomy with tube, $2.4M, 1.9K claims, ranks #1 in-state) are labeled as extreme outliers or top-ranked, implying the hospital is a regional referral center or high-volume provider for pediatric ENT procedures under Medicaid. These relatively high per-claim payments and ranks indicate a specialty surgical footprint beyond routine care.

Several additional codes show elevated state standing for high-dollar services: X4006 ($3.3M, ranks #2 of 52, 98th percentile) and X4011 ($5.1M, 89th percentile) appear among top revenue drivers despite lacking descriptions in the file; their high average paid/claim ($463 for X4006) and state-ranking suggest non-routine or resource-intense services that contribute materially to Medicaid revenue concentration. Analysts should prioritize clarifying the clinical meaning of these X-codes when evaluating service mix.

Tenure is long-standing: the provider’s NPI was enumerated around 2006-06-08 (~20 years ago), indicating roughly two decades of operation under this identifier. This longevity supports interpretation of the observed high volumes as established service lines rather than transient spikes, and it provides more historical context for benchmarking utilization and competitive positions in-state.

Medicaid: Complete Services Breakdown

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

173 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
Y7506	N/A	82,870	$260	$21.1M
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.	20,730	$310	$6.4M
X4011	N/A	21,120	$240	$5.1M
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	75,360	$60	$4.3M
X4006	N/A	7,170	$460	$3.3M
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	62,070	$50	$3.3M
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.	15,160	$180	$2.8M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	950	$2,850	$2.7M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	1,860	$1,290	$2.4M
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.	7,390	$240	$1.8M

Showing 1–10 of 173

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

Mercy Hospital Springfield — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

173 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
X4011	N/A	13	110	5,700	$340	$3.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	23	100	2,240	$80	$2.2M
Y7506	N/A	1	100	980	$250	$1.6M
X4003	N/A	23	70	1,480	$80	$1.1M
X4006	N/A	2	50	370	$780	$969.5K
D7999	N/A	13	20	190	$2,300	$708.3K
Y7507	N/A	38	50	270	$360	$594.9K
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	21	30	80	$120	$440.4K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	32	90	1,850	$120	$384.1K
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.	21	600	140	$170	$384.1K

Showing 1–10 of 173

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mercy Clinic Springfield Communities	MO	Family Medicine Physician	$0	$51.5M
Mercy Hospital Joplin	MO	General Acute Care Hospital	$0	$46.7M
Mercy Hospital Springfield	MO	Land Ambulance	$0	$46.7M
Mercy Clinic Joplin LLC	MO	Family Medicine Physician	$0	$20.4M
Mercy Hospital Carthage	MO	Critical Access Hospital	$0	$18.8M
Mercy Clinic Springfield Communities	MO	Family Medicine Physician	$0	$15.1M
Mercy Hospital Springfield	MO	General Acute Care Hospital	$0	$6.6M
Mercy Hospital Springfield	MO	Air Ambulance	$0	$6.5M
Adam Carver	MO	Ophthalmology Physician	$2.2M	$0
Erica Ballard	MO	Ophthalmology Physician	$1.4M	$0

Nearby Providers

Other providers in the same ZIP code as Mercy Hospital Springfield, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Burrell, Inc.	MO	Community/Behavioral Health Agency	$0	$758.9M
Phoenix Home Care, LLC	MO	Nursing Care Agency	$0	$199.5M
Phoenix Home Care, LLC	MO	In Home Supportive Care Agency	$0	$149M
Integrity Home Care, LLC	MO	Home Health Agency	$0	$115.7M
Preferred Family Healthcare, Inc.	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$23M
Premier Home Health Care, Inc.	MO	Home Health Agency	$0	$12.1M
Burrell, Inc.	MO	Community/Behavioral Health Agency	$0	$9.1M
2gethertech, LLC	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$7.5M
Easter Seals Midwest	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$5.7M
Elite Pain Management, LLC	MO	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$0	$3.5M

Mercy Hospital Springfield — 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