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

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

Mainehealth (NPI 1659392819)

Key Findings

Field	Value
Entity Type	Organization
Organization	Mainehealth
Address	One Medical Center Drive
City	Biddeford
State	ME
ZIP	04005
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 22, 2006

Payer Source	Total Paid
Medicaid	$70.7M
Medicare	$0

MAINEHEALTH reports no Medicare billing on file and is effectively a single-payer (Medicaid) billing entity in the available data, with Total Medicaid revenue of $70.7M. The absence of Medicare revenue on file implies limited exposure to traditional Medicare populations and that Medicaid reimbursement and utilization trends will disproportionately affect the provider's financial profile.

Revenue is highly concentrated in a small set of outpatient/ED services: G0463, 99284, and 99285 together account for 64.8% of this provider's total Medicaid revenue (precomputed). G0463 alone generates $20.2M (39.0% of Medicaid revenue) from 288.6K claims at $70 avg paid/claim, indicating that hospital outpatient clinic assessment visits are the single largest Medicaid revenue driver.

The provider operates a high-volume emergency care footprint: 99284 (52.7K claims, $179 avg paid/claim, $9.4M; 18.2% of Medicaid revenue) ranks #4 of 61 providers in-state (95th percentile; notably above typical state volume for this code), and 99285 (14K claims, $278 avg paid/claim, $3.9M; 7.5%) ranks #9 of 56 (85th percentile; typical, unremarkable volume). This mix (substantial moderate- and high-acuity ED E/M revenue) signals that the ED is a central service line driving Medicaid volumes and reimbursement.

Several procedure and ancillary-service codes show concentrated specialist activity and above-state-average volumes: 64493 (2.9K claims, $360 avg, $1.1M; 100th percentile) ranks #1 of 12 providers in-state and is described as notably above typical state volume, while 96374, 96360, 96365 and 96361 together show significant infusion/IV administration volumes (each listed among top codes) and many rank in high percentiles. These patterns point to substantial procedural, infusion, and interventional outpatient work beyond ED visits.

MAINEHEALTH is a statewide outlier or leader on several preventive and high-volume outpatient codes: 97110 (44.2K claims, $24 avg, $1.1M; 2.0%) ranks #3 of 145 providers (99th percentile; extreme outlier, far above typical state volume for this code), and G0008 (22.6K claims, $27 avg, $610.2K; 1.2%) ranks #3 of 256 (99th percentile; extreme outlier, far above typical state volume). High ranks on 99392/99391/99393 (preventive visits) further indicate a robust primary-care/preventive throughput for Medicaid patients.

Competitive standing is mixed but strong in key outpatient categories: G0463 ranks #5 of 55 (93th percentile; notably above typical state volume), 99284 ranks #4 of 61 (95th percentile; notably above typical state volume), and multiple other codes sit in the 90th+ percentiles. These placements characterize MAINEHEALTH as a major in-state provider for clinic, ED, vaccination, and rehabilitation services, even if some specialized codes remain at typical volumes.

The top-code mix and high percentiles for outpatient clinic visits, ED E/M, immunizations, therapeutic exercise, and diagnostic imaging suggest an operational emphasis on high-throughput ambulatory and emergency services rather than elective inpatient specialty revenue. Codes like 74177, 70450, 71046, 43239 and 45385 appear among the top services but at more typical state percentiles, indicating a balanced imaging and endoscopy portfolio supporting the ED/outpatient focus.

MAINEHEALTH's NPI has been enumerated since 2006-07-22 (~20 years ago), indicating an established presence in the market. Given the provider's long tenure combined with concentrated Medicaid-dependent revenue (Total Medicaid revenue $70.7M and no Medicare billing on file), payers and partners should treat Medicaid reimbursement policy and local Medicaid utilization trends as primary levers affecting this provider's fiscal and operational performance.

Medicaid: Complete Services Breakdown

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

582 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	288,590	$70	$20.2M
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.	52,670	$180	$9.4M
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.	13,990	$280	$3.9M
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.	23,490	$120	$2.9M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	16,300	$110	$1.7M
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.	15,120	$90	$1.3M
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…	44,190	$20	$1.1M
64493	The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance…	2,930	$360	$1.1M
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.	6,450	$140	$883.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	18,150	$40	$689.7K

Showing 1–10 of 582

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Mainehealth — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

582 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	5	60	18,740	$60	$4.6M
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.	4	60	9,550	$100	$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.	9	60	4,690	$180	$1.5M
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.	12	50	11,590	$60	$942.4K
J0585	Injection, onabotulinumtoxina, 1 unit	7	20	1,240	$380	$618.9K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	5	30	6,230	$70	$515.4K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	5	10	400	$400	$476.5K
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.	10	60	2,380	$90	$345.7K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	7	30	200	$250	$316.8K
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.	7	40	5,020	$40	$302.3K

Showing 1–10 of 582

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spurwink Services Inc.	ME	Developmentally Disabled Services Day Training Agency	$0	$38.6M
Northeast Residential Services	ME	In Home Supportive Care Agency	$0	$29.7M
Counseling And Trauma Therapy Associates	ME	Clinical Social Worker	$0	$12.4M
Easy Care Residential	ME	In Home Supportive Care Agency	$0	$10.3M
Maine Behavioral Healthcare	ME	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$7.9M
Remmes Orthodontics, P.A.	ME	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$5.8M
Oceanside Community Services	ME	Community/Behavioral Health Agency	$0	$5.5M
Maine Connect Care LLC	ME	Home Health Agency	$0	$4.3M
Savida Health, PC	ME	Addiction Medicine (Internal Medicine) Physician	$0	$3.9M
Global Home Care, LLC	ME	Home Health Agency	$0	$3.1M

Mainehealth — Billing Profile & Reimbursement Data

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Mainehealth — 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
Mainehealth	ME	General Acute Care Hospital	$0	$142.6M
Mainehealth	ME	Community/Behavioral Health Agency	$0	$115M
Mainehealth	ME	General Acute Care Hospital	$0	$40M
Mainehealth	ME	General Acute Care Hospital	$0	$31.5M
Mainehealth	ME	General Acute Care Hospital	$0	$22.7M
Mainehealth	ME	Rural Health Clinic/Center	$0	$16.7M
Mainehealth	ME	Multi-Specialty Clinic/Center	$0	$10.9M
Mainehealth	ME	Rural Health Clinic/Center	$0	$10M
Mainehealth	ME	Rural Health Clinic/Center	$0	$9.8M
Mainehealth	ME	Rural Health Clinic/Center	$0	$9.6M