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

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

Pediatric Specialists Of Virginia, LLC (NPI 1699119818)

Pediatric Specialists Of Virginia, LLC is a pediatrics physician provider located in Fairfax, Virginia. This profile covers 0 Medicare and 81 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	Pediatric Specialists Of Virginia, LLC
Address	3023 Hamaker Ct
City	Fairfax
State	VA
ZIP	22031
Taxonomy	Pediatrics Physician
NPI Enumerated	April 18, 2013

Payer Source	Total Paid
Medicaid	$11.3M
Medicare	$0

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

81 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	47,290	$80	$3.9M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	16,010	$120	$1.9M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	1,620	$660	$1.1M
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…	15,370	$60	$922.1K
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…	9,730	$80	$807.3K
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…	3,950	$130	$506.1K
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…	1,570	$140	$211.9K
54161	The provider excises the foreskin of a patient older than 28 days; the provider uses a technique other than a clamp, other devices, or dorsal slit.	210	$980	$201.5K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	220	$910	$201.1K
00170	The provider performs anesthesia services for a patient undergoing an intraoral procedure, including biopsy.	1,400	$130	$181K

Showing 1–10 of 81

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Pediatric Specialists Of Virginia, LLC — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

81 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	8	30	600	$1,370	$1.7M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	43	50	1,760	$120	$514.3K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	10	30	50	$1,670	$401.7K
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.	97	150	300	$420	$381.2K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	7	10	50	$1,710	$356.4K
54161	The provider excises the foreskin of a patient older than 28 days; the provider uses a technique other than a clamp, other devices, or dorsal slit.	5	10	210	$1,190	$331.3K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	17	50	110	$840	$309.8K
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…	43	3,520	370	$70	$280.7K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	1,096	1,340	710	$90	$245K
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…	209	4,010	290	$50	$199.8K

Showing 1–10 of 81

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tuyethoa Vinh	VA	Clinical Pathology Physician	$20.9K	$0
Kuntal Jivan	DC	Anesthesiology Physician	$18.5K	$0
Christopher Hayes	DC	Pediatrics Physician	$0	$5.6K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
A Kind & Caring Home Care,llc	VA	Home Health Agency	$0	$35.7M
Alpha Home Care Services LLC	VA	Home Health Agency	$0	$32.2M
Community Living Alternatives, Corp.	VA	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31M
Gateway Healthcare Services LLC	VA	Home Health Agency	$0	$22.1M
Praise Home Health Services, Inc	VA	Home Health Agency	$0	$22M
Grace Home Healthcare, LLC	VA	Home Health Agency	$0	$20.5M
Aloha Home Healthcare Services,llc	VA	Home Health Agency	$0	$13.1M
Precious Care At Home Services Inc	VA	Home Health Aide	$0	$12.5M
Inova Health Care Services	VA	Clinical Medical Laboratory	$5.4M	$6.8M
Dignity Home Care LLC	VA	In Home Supportive Care Agency	$0	$7.5M

Pediatric Specialists Of Virginia, LLC — Billing Profile & Reimbursement Data

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Pediatric Specialists Of Virginia, LLC — 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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