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

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

Scl Health Montana (NPI 1659706232)

Scl Health Montana is a emergency care clinic/center provider located in Billings, Montana. This profile covers 0 Medicare and 11 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	Scl Health Montana
Address	1233 N 30th St
City	Billings
State	MT
ZIP	59101
Taxonomy	Emergency Care Clinic/Center
NPI Enumerated	September 13, 2013

Payer Source	Total Paid
Medicaid	$867.8K
Medicare	$0

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

11 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…	5,360	$80	$402.2K
99203	The provider sees a new 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 provider…	2,430	$110	$255.6K
99204	The provider sees a new 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 provider…	620	$160	$102.2K
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…	790	$130	$99.7K
73100	In this procedure, the provider takes two X–ray images of a patient’s wrist to check for any fracture, swelling, or reason of pain in the wrist area.	270	$10	$2.4K
77077	The provider performs a joint survey study of two or more joints in which he performs only a single view of each joint.	70	$20	$1.3K
72081	In this diagnostic procedure, the provider captures the entire thoracic (upper and middle) and lumbar (lower) spine in an X–ray image from a single projection (direction or angle) to evaluate the…	100	$10	$1.2K
99221	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	10	$100	$1.2K
73610	In this procedure, the provider takes three or more X–ray images of the ankle joint to check for any fracture, swelling, or reason for pain in the ankle area.	110	$10	$950
73521	In this diagnostic procedure, the provider takes two X–ray images from different projections (directions or angles) of both hips, left and right, to check for fracture, swelling, or other reasons for…	70	$10	$810

Showing 1–10 of 11

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Scl Health Montana — 1 of 11 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

11 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	231	530	580	$70	$224.6K
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…	92	520	730	$40	$196.4K
99204	The provider sees a new 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 provider…	18	130	100	$120	$49.4K
99203	The provider sees a new 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 provider…	17	190	130	$70	$37.2K
99221	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	11	10	160	$90	$26.3K
73610	In this procedure, the provider takes three or more X–ray images of the ankle joint to check for any fracture, swelling, or reason for pain in the ankle area.	32	50	260	$10	$5.6K
73100	In this procedure, the provider takes two X–ray images of a patient’s wrist to check for any fracture, swelling, or reason of pain in the wrist area.	2	10	40	$20	$2.8K
72081	In this diagnostic procedure, the provider captures the entire thoracic (upper and middle) and lumbar (lower) spine in an X–ray image from a single projection (direction or angle) to evaluate the…	1	10	90	$20	$1.7K
73521	In this diagnostic procedure, the provider takes two X–ray images from different projections (directions or angles) of both hips, left and right, to check for fracture, swelling, or other reasons for…	2	10	70	$20	$1.4K
77077	The provider performs a joint survey study of two or more joints in which he performs only a single view of each joint.	2	10	70	$20	$1.2K

Showing 1–10 of 11

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Scl Health Medical Group - Billings LLC	MT	Clinic/Center	$0	$32.2M
Scl Health Montana	MT	General Acute Care Hospital	$0	$13.5M
Scl Health Montana	MT	Durable Medical Equipment & Medical Supplies	$0	$2.7M
Douglas Debenham	IN	Radiation Oncology Physician	$1.8M	$0
Eric Maranda	MT	Dermatology Physician	$1.1M	$0
Zachary Arthurs	SC	Vascular Surgery Physician	$641.3K	$0
Mohamad El-zaru	MA	Cardiovascular Disease Physician	$543.5K	$0
Joseph Apostol	MT	Cardiovascular Disease Physician	$461.8K	$0
Scl Health Montana	MT	Oncology Clinic/Center	$0	$448.6K
Jared Heaton	UT	MOHS-Micrographic Surgery Physician	$447.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Billings Clinic	MT	General Practice Physician	$0	$53.8M
Rimrock Foundation	MT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$44.9M
Residential Support Services	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$30.6M
Billings Public School District 2	MT	Local Education Agency (LEA)	$0	$19.2M
South Central Montana Regional Mental Health Center	MT	Clinic/Center	$0	$16.6M
Billings Clinic	MT	Emergency Care Clinic/Center	$0	$15.7M
Community Solutions Incorporated	MT	Clinical Medical Laboratory	$0	$14.1M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$10.8M
American Medical Response Ambulance Service Inc	MT	Ambulance	$2.1M	$6.7M
Yellowstone Pathology Institute, Inc.	MT	Clinical Medical Laboratory	$777.4K	$4.4M

Scl Health Montana — Billing Profile & Reimbursement Data

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Scl Health Montana — 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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