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.

Lake Cumberland Regional Hospital LLC (NPI 1619038247)

Field	Value
Entity Type	Organization
Organization	Lake Cumberland Regional Hospital LLC
Address	305 Langdon Street
City	Somerset
State	KY
ZIP	42502
Taxonomy	Rural Acute Care Hospital
NPI Enumerated	December 13, 2006

Payer Source	Total Paid
Medicaid	$77.8M
Medicare	$0

Key Findings

LAKE CUMBERLAND REGIONAL HOSPITAL LLC is effectively a single-payer facility in the available data, with no Medicare billing on file and $77.8M in lifetime Medicaid revenue; this indicates the hospital’s public payer exposure in our dataset is concentrated entirely in Medicaid rather than a mixed Medicare/Medicaid case mix. The provider’s NPI was enumerated on 2006-12-13, indicating roughly 20 years of active registration in the national provider registry and a stable tenure in the market.

Revenue concentration within Medicaid is high: the precomputed top three Medicaid codes account for 47.5% of the provider’s total Medicaid revenue, which signals heavy dependence on a small set of high-revenue services rather than a broad, evenly spread service mix. This concentration suggests business risk if reimbursement or utilization for those specific services changes.

The hospital’s Medicaid billing profile is dominated by emergency department E/M services: 99285 ($13.4M, 24.8% of Medicaid revenue) and 99284 ($7M, 13.0%) together represent a major portion of revenue, implying the facility operates a high-volume ED handling moderate-to-high acuity cases. Combined with substantial observation hours (G0378, $2.2M) and frequent low-, moderate- and high-level ED E/M codes, the code mix is consistent with a rural acute care hospital serving as a primary emergency and acute intake center for its region.

Imaging and interventional cardiology are additional revenue drivers: CT abdomen/pelvis without contrast 74176 ($5.2M, 9.6%) ranks #6 in-state and 93458 ($2.9M, 5.3%) ranks #4 in-state, both labeled as notably above typical state volume. These placements indicate the hospital performs above-typical volumes for advanced diagnostic imaging and cath-lab imaging interpretation relative to in-state peers, supporting a service line emphasis on diagnostic radiology and cardiac catheterization imaging.

On competitive standing for Medicaid codes, several high-volume services place the hospital well above typical state volumes: 74176 ranks in the 97th percentile and 93458 in the 95th percentile for in-state providers, signaling the hospital is a regional leader in those procedures. Other frequent services such as 36415 (blood draw) and 96372 (injections) are extreme or notable outliers in volume (36415 at the 98th percentile; 96372 at the 99th percentile), which suggests the facility processes very high patient throughput for routine hospital procedures compared with most Kentucky peers.

Most of the remaining top Medicaid codes show typical, unremarkable statewide volumes (many in the 70–90th percentiles), including common imaging, lab, and ED services like 99283, 74177, 70450, and 71046; this pattern indicates that outside its concentration in ED, CT and cath imaging, the hospital’s broader service lines present as expected for a rural acute care hospital rather than unusually specialized.

Operationally, the mix of high-volume ED E/M codes (99285, 99284, 99283), large claim counts for basic nursing/infusion codes (96374, 96375, 96365), and very high volumes for basic lab and blood-draw codes (80053, 36415) point to sustained high patient throughput and significant inpatient/observation flows. Coupled with strong CT and cardiology imaging volumes, the profile is consistent with a full-service rural acute hospital that funnels emergency patients into imaging, cath, observation, and short-term inpatient care.

Given the lack of Medicare billing on file, payers and competitive analysts should treat this facility as Medicaid-centric in our dataset; contracting, utilization management, and network adequacy reviews should emphasize Medicaid utilization patterns and capacity for high ED and imaging volumes rather than Medicare-specific benchmarks. The heavy reliance on a few high-revenue Medicaid codes increases sensitivity to policy or utilization shifts affecting ED, CT, and cath-lab imaging services.

Medicaid: Complete Services Breakdown

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

388 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	50,010	$270	$13.4M
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.	44,050	$160	$7M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	15,380	$340	$5.2M
93458	In this procedure, the provider performs imaging supervision and interpretation for a coronary angiography with left heart catheterization and intraprocedural injections for left ventriculography. He…	3,190	$900	$2.9M
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.	24,570	$120	$2.9M
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.	6,440	$390	$2.5M
G0378	Hospital observation service, per hour	8,660	$250	$2.2M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	10,820	$170	$1.9M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	38,250	$40	$1.6M
Q9967	Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	20,270	$70	$1.5M

Showing 1–10 of 388

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

Lake Cumberland Regional Hospital LLC — 3 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

388 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	170	310	830	$120	$3.7M
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.	28	280	7,150	$150	$3M
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.	16	240	4,710	$150	$2.6M
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.	56	280	5,700	$120	$2M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	29	40	740	$1,170	$1.7M
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.	52	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	20	90	2,770	$190	$1.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	50	80	7,740	$30	$1.1M
C1713	Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)	9	40	550	$910	$1.1M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	6	170	2,610	$250	$1M

Showing 1–10 of 388

Related Providers

Other providers that share a Tax Identification Number (TIN) with Lake Cumberland Regional Hospital LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lake Cumberland Regional Hospital, LLC	KY	Internal Medicine Physician	$0	$15.6M
Mateen Ahmed	KY	Pulmonary Disease Physician	$121.1K	$0
Paul Snowdy	IA	Physician Assistant	$69.8K	$0
Katie Aaron	KY	Family Nurse Practitioner	$47.8K	$0
Patrick Jenkins	KY	Family Medicine Physician	$44.4K	$0
Michael Citak	KY	Surgery Physician	$17.9K	$0
Andrew Vaughn	TX	Otolaryngology Physician	$2.1K	$0

Lake Cumberland Regional Hospital LLC — Billing Profile & Reimbursement Data

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Lake Cumberland Regional Hospital LLC — 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

Frequently Asked Questions

References