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

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

Genesis Healthcare System (NPI 1598868655)

Key Findings

Field	Value
Entity Type	Organization
Organization	Genesis Healthcare System
Address	2951 Maple Ave
City	Zanesville
State	OH
ZIP	43701
Taxonomy	General Acute Care Hospital
NPI Enumerated	September 6, 2006

Payer Source	Total Paid
Medicaid	$101.8M
Medicare	$0

GENESIS HEALTHCARE SYSTEM is effectively a single‑payer Medicaid provider: there is no Medicare billing on file while Total Medicaid revenue is $101.8M. The absence of Medicare activity means the provider’s billing profile and financial footprint are concentrated entirely in Medicaid claims, which concentrates payer risk and competitive comparisons to in‑state peers rather than national Medicare benchmarks.

Revenue concentration is high at the top of the Medicaid code list: the precomputed top three codes—99283 ($12M, 16.9%), 96361 ($11.1M, 15.6%), and 99284 ($6.4M, 9.0%)—together account for 41.5% of the provider’s total Medicaid revenue. This indicates a small set of high‑revenue services dominate Medicaid receipts and should be the focus for contract negotiations, utilization review, and capacity planning.

The code mix points to a hospital operating with a high-volume emergency department and infusion/observation services. Multiple high‑revenue and high‑volume ED E/M codes appear near the top of the list (99283, 99284, 99285, 99282) alongside large volumes of IV/infusion codes (96361, 96365, 96360, 96366) and observation hours (G0378), signaling frequent ED presentations that require fluids, infusions, and short‑stay observation.

GENESIS shows strong in‑state competitive standing on several Medicaid services: 99283 ranks #22 of 484 providers in‑state (96th percentile; notably above typical state volume for this code) and 96361 ranks #7 of 165 providers in‑state (96th percentile; notably above typical state volume for this code). These high ranks indicate regional strength in emergency care and infusion services compared with peers.

There are pronounced statistical outliers in outpatient/clinic visit volumes and certain ancillary services. 99212 is an extreme outlier, ranking #9 of 1608 providers in‑state (100th percentile; extreme outlier), and other codes such as 97110 (21 of 841, 98th percentile; notably above typical state volume) and 43239 (8 of 280, 97th percentile; notably above typical state volume) also sit in very high percentiles, showing unusually large outpatient therapy and endoscopy volumes for an in‑state hospital.

Service breadth extends beyond ED and infusion: the provider reports sizable Medicaid activity in imaging (74177, 70450), sleep studies (95810), endoscopy/colonoscopy (43239, 45380), physical therapy (97110), and oncology infusions (96413, J9271). While J9271 ($1.5M) ranks #14 of 22 providers in‑state (33th percentile; typical, unremarkable volume for this code), the presence of chemotherapy and infusion CPTs indicates the hospital supports oncology and procedural workflows in addition to acute care.

Some high‑volume diagnostic and lab testing codes appear at scale but with typical in‑state standing: 80053 (90.6K claims, $1.2M revenue) ranks #16 of 274 providers in‑state (95th percentile; typical, unremarkable volume for this code) and U0003 (23.7K claims, $4.4M revenue) ranks #13 of 141 providers in‑state (91th percentile; typical, unremarkable volume for this code). These volumes reflect routine inpatient/outpatient diagnostic throughput supporting the hospital’s acute and ED caseload rather than unique specialization.

The provider has a long operational history at the NPI level, enumerated (registered) 2006-09-06 (~20 years ago). This tenure, combined with concentrated Medicaid revenue and multiple high in‑state percentiles across ED, infusion, imaging, and endoscopy codes, suggests an established regional hospital whose Medicaid business is driven by emergency care and related acute services.

Medicaid: Complete Services Breakdown

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

633 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	106,180	$110	$12M
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.	38,820	$290	$11.1M
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.	53,110	$120	$6.4M
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,…	53,200	$90	$4.7M
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.	37,360	$120	$4.6M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	23,680	$190	$4.4M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	29,610	$110	$3.3M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	13,120	$230	$3M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	33,040	$70	$2.4M
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…	24,430	$100	$2.3M

Showing 1–10 of 633

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Genesis Healthcare System — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

633 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	46	150	4,030	$100	$5.9M
J9271	Injection, pembrolizumab, 1 mg	14	20	360	$8,480	$5M
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.	7	170	4,660	$300	$2.6M
J9299	Injection, nivolumab, 1 mg	6	10	210	$6,940	$2.1M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	247	610	1,350	$150	$1.9M
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.	22	480	4,510	$90	$1.8M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	13	20	480	$730	$1.6M
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.	51	660	460	$90	$1.5M
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.	49	580	510	$100	$1.3M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	13	140	1,130	$90	$1.1M

Showing 1–10 of 633

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spero Health Of Ohio, LLC	OH	Substance Use Disorder Rehabilitation Clinic/Center	$0	$46M
Allwell Behavioral Health Services	OH	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$35M
Muskingum Valley Health Centers	OH	Federally Qualified Health Center (FQHC)	$0	$28.7M
Mid-ohio Behavioral Health LLC	OH	Mental Health Counselor	$0	$28.6M
Genesis Medical Group LLC	OH	General Practice Physician	$0	$15.2M
Genesis Emergency Physicians LLC	OH	Emergency Medicine Physician	$0	$10.8M
Muskingum Valley Health Centers	OH	Federally Qualified Health Center (FQHC)	$0	$9.7M
Genesis Primary Care Physicians LLC	OH	Family Medicine Physician	$0	$7.1M
Coler Hospice, Ltd	OH	Community Based Hospice Care Agency	$0	$6.7M
Community Ambulance Service	OH	Ambulance	$1.2M	$3.7M

Genesis Healthcare System — 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

Nearby Providers

Frequently Asked Questions

References