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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Community Health Systems, Inc. (NPI 1588738538)

Key Findings

Field	Value
Entity Type	Organization
Organization	Community Health Systems, Inc.
Address	228 Melon St
City	Beckley
State	WV
ZIP	25801
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	November 20, 2006

Payer Source	Total Paid
Medicaid	$35M
Medicare	$0

COMMUNITY HEALTH SYSTEMS, INC. is effectively a single-payer Medicaid operation: there is no Medicare billing on file and all reported lifetime revenue is Medicaid-based ($35M). This concentration makes Medicaid reimbursement policy the primary determinant of the provider’s revenue trajectory and payer exposure.

Revenue is highly concentrated in a single encounter code: T1015 accounts for $24.4M (75.2% of this provider's total Medicaid revenue) and the precomputed top-3 codes account for 82.0% of total Medicaid revenue. This level of concentration indicates the organization relies heavily on all-inclusive clinic encounter payments rather than a broad mix of high-value procedural billing.

The code mix points to an FQHC operating model with large primary care throughput plus substantial women’s health and prenatal services. High volumes for obstetric ultrasound and delivery codes (e.g., 76816, 76830, 76805, 76801, 76819, 59409, 59514) alongside dominant clinic encounter coding suggest bundled visit support for prenatal and family health services within the clinic footprint.

Several ancillary and support-service codes show meaningful onsite capability: large claim volumes for specimen preparation/transport (99000: 55.8K claims, $390.7K revenue), phlebotomy (36415: 38.7K claims, $271K), lab panels (80053: 17.5K claims, $122.8K; 80061: 12.7K claims, $113.9K), multiplex respiratory testing (87637: 2.8K claims, $293.9K), and immunizations (90460: 8.5K claims, $118.5K). Together these indicate integrated lab, diagnostic, and preventive services are a meaningful part of operations.

State-level competitive standing is dominant for several codes: T1015 ranks #2 of 385 providers in-state (100th percentile; extreme outlier), 99213 ranks #7 of 1273 providers (100th percentile; extreme outlier), and 76816 ranks #2 of 52 providers (98th percentile; extreme outlier). Those rankings signal the provider is a major volume leader in clinic encounters and selected obstetric imaging relative to in-state peers.

Operational throughput is very high across multiple encounter codes: 224K claims for T1015 and 126.4K claims for 99213, plus large volumes for 99214 (32.6K claims) and 99000 (55.8K claims). These counts are consistent with a high-visit ambulatory model typical of FQHCs and imply significant staffing and capacity dedicated to recurrent outpatient encounters.

The provider’s dependence on T1015-style all-inclusive clinic encounters (75.2% of Medicaid revenue) creates potential revenue sensitivity to changes in encounter definitions, encounter rate-setting, or payer audits of bundled services. From a contracting and risk-management perspective, payers and partners should note the concentration risk when designing value-based arrangements or rate adjustments.

The NPI was enumerated on 2006-11-20 (~20 years ago), indicating an established presence in the market. When combined with the extreme-outlier volume and rank signals across multiple codes, this tenure supports the view that the provider has an entrenched operational footprint in its service area and statewide role on key Medicaid codes.

Medicaid: Complete Services Breakdown

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

170 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	223,980	$110	$24.4M
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…	126,370	$10	$1.4M
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	12,230	$70	$795.1K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	990	$720	$716.8K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	6,340	$70	$462.8K
77067	The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software…	9,020	$50	$450.8K
99000	Use this code for the in office preparation of a specimen for lab analysis and or its transport from the office to the outside testing laboratory.	55,810	$10	$390.7K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	9,140	$40	$356.6K
76805	In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks…	3,400	$90	$306.1K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	2,830	$100	$293.9K

Showing 1–10 of 170

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Community Health Systems, Inc. — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

170 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	2	390	4,610	$130	$2.2M
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.	102	160	3,690	$80	$714.8K
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.	26	110	5,530	$20	$344.8K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	16	30	2,810	$100	$340.9K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	4	20	150	$700	$308.2K
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…	7	1,270	1,240	$30	$245K
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…	32	140	3,080	$20	$243.1K
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…	46	190	660	$40	$226.4K
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…	23	1,030	890	$50	$221K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	63	80	2,960	$20	$198.8K

Showing 1–10 of 170

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Health Systems, Inc.	WV	Obstetrics & Gynecology Physician	$0	$11.9M
Community Health Systems, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$2.3M
Community Health Systems Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$2.1M
Community Health Systems Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$1.1M
Rodney Fink	WV	Family Medicine Physician	$487.5K	$0
Angel Rosas-acevedo	WV	Diagnostic Radiology Physician	$336.3K	$0
Andrew Thymius	WV	Interventional Pain Medicine Physician	$199.7K	$0
Harold Harvey	WV	Internal Medicine Physician	$132.8K	$4.3K
Richard Shorter	WV	Family Medicine Physician	$119.9K	$0
Scott Berneburg	WV	Podiatrist	$91K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Raleigh General Hospital LLC	WV	General Acute Care Hospital	$0	$36.4M
Fmrs Health Systems Inc	WV	Community/Behavioral Health Agency	$0	$27M
Health Care Alliance, Inc.	WV	Emergency Medicine Physician	$0	$25M
Jan-care Ambulance Of Raleigh County Inc	WV	Land Ambulance	$1.9M	$20.8M
Appalachian Regional Healthcare, Inc	WV	General Acute Care Hospital	$0	$18.3M
Raleigh County Commission On Aging, Inc.	WV	Home Health Agency	$0	$16.7M
Mountain State Home Health Care Inc	WV	Nursing Care Agency	$0	$16.5M
Family Options Providers, LLC.	WV	Community/Behavioral Health Agency	$0	$16.1M
Raleigh County Commission On Aging, Inc.	WV	Home Health Agency	$0	$13.8M
Daniel Foley	WV	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$9.7M

Community Health Systems, Inc. — Billing Profile & Reimbursement Data

Sign up for Community Health Systems, Inc. — Billing Profile & Reimbursement Data policy alerts

Community Health Systems, Inc. — Billing Profile & Reimbursement Data

Sign up for Community Health Systems, Inc. — Billing Profile & Reimbursement Data policy alerts

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