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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Wake Forest University Health Sciences (NPI 1639454499)

Wake Forest University Health Sciences is a multi-specialty clinic/center provider located in Lexington, North Carolina. This profile covers 0 Medicare and 84 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	Wake Forest University Health Sciences
Address	1303 Greensboro Street Ext
City	Lexington
State	NC
ZIP	27295
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	October 12, 2011

Payer Source	Total Paid
Medicaid	$11.9M
Medicare	$0

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

84 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…	55,490	$60	$3.1M
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…	29,650	$80	$2.3M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	372,230	$10	$2.2M
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…	9,440	$90	$868K
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…	8,930	$90	$768.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6,250	$90	$543.3K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	13,510	$40	$499.9K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	23,640	$20	$449.2K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3,120	$100	$302.9K
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…	14,420	$10	$129.8K

Showing 1–10 of 84

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Wake Forest University Health Sciences — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

84 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	84	2,850	10,910	$10	$330.3K
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…	100	4,400	960	$60	$271.3K
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…	47	520	1,080	$80	$262.1K
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…	43	550	970	$90	$258.9K
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…	121	140	3,810	$30	$223.5K
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…	55	4,130	670	$50	$219.9K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	78	160	420	$60	$183K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	56	590	490	$90	$179.8K
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.	262	380	460	$40	$173.1K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	114	300	140	$130	$121.5K

Showing 1–10 of 84

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wake Forest University Health Sciences	NC	Multi-Specialty Clinic/Center	$0	$188.2M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Afc Urgent Care And Family Care Of Wnc, PLLC	NC	Urgent Care Clinic/Center	$0	$9.4M
Keegan Harkins	NE	Ophthalmology Physician	$3.5M	$0
Jedediah Mcclintic	PA	Ophthalmology Physician	$3.2M	$18.9K
Claudia Hooten	TX	Retina Specialist (Ophthalmology) Physician	$2.6M	$0
Donald Vile	VA	Hematology & Oncology Physician	$1.4M	$0
Mark Nelson	NC	Retina Specialist (Ophthalmology) Physician	$1.1M	$0
Omar Sangueza	NC	Dermatopathology (Pathology) Physician	$810.1K	$0
Brian Zamora	NC	Retina Specialist (Ophthalmology) Physician	$793.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Treatment Centers LLC	NC	Community/Behavioral Health Agency	$330.4K	$21.2M
Brookstone Retirement Ctr.,llc.	NC	Assisted Living Facility	$0	$9.5M
Providence Transportation Inc	NC	Land Ambulance	$500.3K	$190.5K
A1 Pharmacy And Surgical Supply, LLC	NC	Community/Retail Pharmacy	$72.8K	$397.8K
Penny Jones	NC	Acute Care Nurse Practitioner	$11.5K	$0

Wake Forest University Health Sciences — 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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