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.

Highland Pediatrics (NPI 1619009792)

Highland Pediatrics is a pediatrics physician provider located in Fall River, Massachusetts. This profile covers 0 Medicare and 78 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	Highland Pediatrics
Address	1030 President Ave
City	Fall River
State	MA
ZIP	02720
Taxonomy	Pediatrics Physician
NPI Enumerated	March 12, 2007

Payer Source	Total Paid
Medicaid	$8.1M
Medicare	$0

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

78 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…	42,480	$50	$2M
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…	25,760	$70	$1.7M
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…	12,690	$70	$837.5K
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…	10,180	$70	$671.9K
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.	26,560	$20	$504.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6,480	$70	$433.9K
S0302	Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)	42,750	$10	$384.8K
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…	29,700	$10	$267.3K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	2,000	$80	$164K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,110	$80	$160.4K

Showing 1–10 of 78

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

Highland Pediatrics — 14 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

78 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0299	Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes	286	310	8,710	$40	$1.6M
T1015	Clinic visit/encounter, all-inclusive	238	550	90	$140	$1.5M
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…	66	130	1,830	$60	$974.3K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	278	370	500	$40	$605.1K
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…	1,604	1,620	580	$80	$599.6K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	194	200	450	$30	$511.5K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	133	220	410	$20	$216.4K
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,…	385	950	90	$100	$212.9K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	132	220	360	$20	$211.8K
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…	92	5,040	200	$70	$209.5K

Showing 1–10 of 78

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Maureen Crotty	RI	Pediatrics Physician	$0	$695.5K
Malini Gillen	RI	Pediatric Adolescent Medicine Physician	$0	$425.6K
Katherine Weingartner	RI	Pediatrics Physician	$0	$343.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southcoast Hospitals Group, Inc	MA	General Acute Care Hospital	$0	$97.6M
Stanley Street Treatment And Resources, Inc.	MA	Substance Abuse Rehabilitation Facility	$672.8K	$38.4M
Family Service Association Of Greater Fall River	MA	Case Management Registered Nurse	$0	$36.5M
Family Service Association Of Greater Fall River, Inc.	MA	Mental Health Counselor	$0	$32.9M
Steppingstone Inc	MA	Multi-Specialty Clinic/Center	$0	$29.9M
Stanley Street Treatment And Resources, Inc	MA	Federally Qualified Health Center (FQHC)	$0	$18.4M
First Physicians Corporation	MA	Emergency Medicine Physician	$0	$12.7M
Bay State Afc, LLC	MA	Foster Care Agency	$0	$11.3M
Saint Vincent's Services, Inc.	MA	Adolescent and Children Mental Health Clinic/Center	$0	$10.3M
Alert Ambulance Service, Inc	MA	Land Ambulance	$2M	$6.5M

Highland Pediatrics — Billing Profile & Reimbursement Data

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Highland Pediatrics — 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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