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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Presbyterian Healthcare Services (NPI 1629053509)

Key Findings

Field	Value
Entity Type	Organization
Organization	Presbyterian Healthcare Services
Address	2100 Martin Luther King Jr Blvd
City	Clovis
State	NM
ZIP	88101
Taxonomy	Rural Acute Care Hospital
NPI Enumerated	December 13, 2005

Payer Source	Total Paid
Medicaid	$47.6M
Medicare	$0

The provider’s Medicaid billing profile is heavily emergency-department driven: the three ED evaluation-and-management codes 99284, 99283, and 99285 together account for 47.2% of this provider’s total Medicaid revenue, and each appears near the top of its in‑state peer list (99284: 30.4K claims, $219 avg paid/claim, $6.7M revenue, 18.1%; 99283: 34.1K claims, $159 avg paid/claim, $5.4M revenue, 14.7%; 99285: 18.5K claims, $287 avg paid/claim, $5.3M revenue, 14.4%). This concentration of ED E/M codes indicates the hospital’s operations and revenue base are centered on urgent and emergent care throughput.

Top-line revenue concentration is material: Medicaid is the only payer with billing on file and the provider reports $47.6M in total Medicaid revenue, with the top three codes producing 47.2% of that amount. That degree of concentration in a small set of ED codes suggests financial sensitivity to changes in emergency-department volume or reimbursement for those specific services.

This hospital is effectively single‑payer in the available data: there is no Medicare billing on file while Medicaid accounts for $47.6M in lifetime revenue. The absence of Medicare volume implies different risk and contract dynamics than multi‑payer peers and means analyses of hospital performance should focus on Medicaid payment policies and local managed‑Medicaid networks.

Competitive standing on the ED codes is generally solid but not dominant statewide: 99284 ranks #19 of 76 providers in‑state (76th percentile), 99283 ranks #13 of 84 (86th percentile), and 99285 ranks #16 of 71 (79th percentile), all labeled as typical or unremarkable volumes in the dataset. In plain terms, the hospital is a meaningful regional ED participant with above‑median activity but is not an outlier leader for these codes across New Mexico.

Ancillary acute‑care services—imaging, observation, and lab testing—make up a significant portion of Medicaid revenue alongside ED care. Notable entries include 74177 CT abdomen/pelvis with contrast (5.8K claims, $410 avg paid/claim, $2.4M revenue, 6.4%), 70450 CT head without contrast (6.2K claims, $168 avg paid/claim, $1M revenue, 2.8%), and multiplex infectious-disease testing 87636 (13.4K claims, $128 avg paid/claim, $1.7M revenue, 4.7%), which together reflect in‑house imaging and lab capabilities that support ED and inpatient workflows.

Short‑stay and outpatient throughput are also evident: hospital observation service G0378 (2.8K claims, $602 avg paid/claim, $1.7M revenue, 4.6%) and hospital outpatient clinic visits G0463 (21.3K claims, $43 avg paid/claim, $913.8K revenue, 2.5%) indicate routine use of observation and clinic settings to manage ED arrivals. High volumes of 93005 EKG recording (21.5K claims, $58 avg paid/claim, $1.2M revenue, 3.4%) further underscore frequent low‑complexity cardiac evaluation consistent with an active ED and observation unit.

A small set of procedure codes show unusually high state percentiles or are flagged as notable in the dataset: 94640 (oxygen therapy/airway opening) ranks #4 of 84 providers in‑state at the 96th percentile and is described as notably above typical state volume for this code. Several lab and panel codes appear in very high percentiles (for example, 80053 at the 93th percentile and 85025 at the 92th percentile) even when labeled as typical in the source, which together signal relatively high testing intensity consistent with an ED‑focused rural acute care hospital.

The provider’s NPI was enumerated on 2005-12-13 (~21 years ago), indicating a long tenure in CloVIS, NM as a rural acute care hospital. Coupled with the concentrated ED, observation, imaging, and lab mix, this tenure and code profile are consistent with a stable regional service hub rather than a new market entrant.

Medicaid: Complete Services Breakdown

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

315 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	30,390	$220	$6.7M
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.	34,110	$160	$5.4M
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.	18,490	$290	$5.3M
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.	5,770	$410	$2.4M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	13,420	$130	$1.7M
G0378	Hospital observation service, per hour	2,820	$600	$1.7M
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…	21,460	$60	$1.2M
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.	6,160	$170	$1M
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.	59,420	$20	$1M
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…	14,740	$70	$973.1K

Showing 1–10 of 315

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Presbyterian Healthcare Services — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

315 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	19	80	12,050	$160	$3.9M
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	70	6,920	$210	$3.5M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	9	40	3,670	$80	$3.2M
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.	13	80	10,650	$130	$2.4M
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.	15	60	3,070	$210	$1.4M
G0378	Hospital observation service, per hour	9	40	1,000	$400	$1M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	3	30	3,760	$120	$900.7K
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.	15	60	2,820	$110	$799.5K
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…	7	50	7,300	$60	$737.6K
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.	20	80	3,340	$60	$595K

Showing 1–10 of 315

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Clovis Homecare, Inc.	NM	Home Health Agency	$0	$84M
Enmrsh, Inc.	NM	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$51.9M
Mental Health Resources, Inc.	NM	Mental Health Counselor	$0	$31M
Absolutely You, LLC	NM	Developmentally Disabled Services Day Training Agency	$0	$26.2M
K-bee Homcare Services, LLC	NM	In Home Supportive Care Agency	$0	$18.3M
Genesis Home Care LLC	NM	Personal Care Attendant	$0	$17.3M
New Mexico Healthcare Services, LLC	NM	Home Health Agency	$0	$16.6M
Enmrsh, Inc.	NM	Early Intervention Provider Agency	$0	$11.6M
Curry Emergency Group LLC	NM	Emergency Medicine Physician	$0	$9.6M
Familia Dentalclovis LLC	NM	General Practice Dentistry	$0	$5.6M

Presbyterian Healthcare Services — Billing Profile & Reimbursement Data

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Presbyterian Healthcare Services — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Presbyterian Healthcare Services	NM	General Acute Care Hospital	$0	$345.3M
Presbyterian Healthcare Services	NM	Internal Medicine Physician	$0	$240.8M
Centra Medical Group, LLC	VA	Family Medicine Physician	$0	$60.1M
Presbyterian Healthcare Services	NM	Rural Acute Care Hospital	$0	$40.9M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$33.1M
Presbyterian Healthcare Services	NM	General Acute Care Hospital	$0	$21.6M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$20.6M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$8.5M
Christopher Roybal	NM	Ophthalmology Physician	$3.8M	$0
Presbyterian Healthcare Services	NM	Home Health Agency	$0	$3.3M