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

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

Covenant Medical Center Inc (NPI 1700827896)

Key Findings

Field	Value
Entity Type	Organization
Organization	Covenant Medical Center Inc
Address	3421 W 9th St
City	Waterloo
State	IA
ZIP	50702
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 9, 2006

Payer Source	Total Paid
Medicaid	$63.2M
Medicare	$0

This provider is effectively single‑payer in scope: there is no Medicare billing on file and all reported federal payer revenue is Medicaid, with total Medicaid revenue of $63.2M. That concentration means analyses and contracting discussions should treat Medicaid patterns as representative of the hospital’s entire federal payer footprint rather than one part of a mixed Medicare/Medicaid portfolio.

Revenue is highly concentrated in a very small set of outpatient and ED codes: the precomputed top 3 Medicaid codes account for 74.4% of the provider’s total Medicaid revenue, led by G0463 at $36.6M (61.0% of Medicaid revenue), followed by 99284 at $5.3M (8.8%) and 99283 at $2.7M (4.6%). This concentration signals that a single operational area—hospital outpatient clinic visits plus associated ED evaluation codes—drives the bulk of billed Medicaid dollars.

G0463 dominance (385.7K claims, $95 avg paid/claim) indicates this facility functions as a very high‑volume hospital outpatient clinic and intake center; G0463 ranks #3 of 70 in‑state (97th percentile) and is described as an extreme outlier, far above typical state volume for this code. The scale of G0463 relative to total revenue makes the hospital’s outpatient clinic operations the strategic core of its Medicaid business and a primary locus for utilization management or network negotiations.

Emergency department activity is a clear secondary revenue stream: 99284 (23.7K claims, $222 avg paid/claim) and 99283 (19.8K claims, $139 avg paid/claim) together generate meaningful Medicaid revenue and indicate large ED throughput with a mix of moderate and low complexity visits. 99284 ranks #22 of 275 (92th percentile; notably above typical state volume for this code) while 99283 ranks #24 of 305 (92th percentile; typical, unremarkable volume), suggesting the facility treats a broad spectrum of ED acuity and is a notable statewide ED participant for mid‑level visits.

The provider is a statewide outlier on several preventive, vaccination, screening, and diagnostic testing codes, pointing to broad primary care and public‑health activity co‑located within the hospital system. High volumes include 90471 (29.8K claims, $40 avg paid/claim; $1.2M revenue) which ranks #4 of 572 (99th percentile; extreme outlier), 96110 (9K claims, $62 avg paid/claim; $555.5K revenue) which ranks #3 of 98 (98th percentile; extreme outlier), and COVID testing codes 87811 (12K claims, $480.8K revenue) which ranks #1 of 67 (100th percentile; extreme outlier) and U0003 (5.1K claims, $304.3K revenue) rank #6 of 64 (92th percentile).

The hospital also reports notable specialty or unique services relative to state peers: 41874 (alveoloplasty) generated $937.1K and ranks #1 of 1 providers in‑state (0th percentile; no state peer volume comparison available), indicating it may be the sole reported in‑state provider for that surgical dental service in Medicaid data. Similarly, observation services G0378 rank #1 of 27 (100th percentile; notably above typical state volume), confirming capacity for short‑term inpatient/observation care tied to its high outpatient/ED throughput.

Several service lines show consistently high percentile placement even when dollar share is smaller, underlining competitive strength across multiple outpatient functions. Preventive well visits (99391/99392/99393/99394) and allied services such as speech evaluation 92507 and group psychotherapy 90853 appear at or above the 86th–98th percentiles statewide, which suggests the system supports integrated pediatric, behavioral health, and rehabilitation workflows in addition to its outpatient clinic and ED activity.

This provider has an established presence—NPI enumerated 2006-06-09 (~20 years ago)—so the observed utilization patterns reflect long‑standing operational choices rather than a short‑term spike. Given the age of enumeration combined with the concentrated outpatient/ED revenue profile, analysts should consider this facility a mature, community acute‑care hospital with a very large hospital outpatient clinic footprint and substantial ancillary services that dominate its Medicaid business.

Medicaid: Complete Services Breakdown

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

254 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	385,660	$100	$36.6M
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.	23,700	$220	$5.3M
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.	19,760	$140	$2.7M
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.	5,070	$420	$2.1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	9,990	$120	$1.2M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	19,240	$60	$1.2M
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	29,780	$40	$1.2M
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…	12,430	$80	$981.8K
41874	Alveoloplasty is done prior to placement of a dental prosthesis. In order to facilitate smooth fitting of the denture, the dentist performs alveoloplasty to make the alveolar process smoother.…	460	$2,060	$937.1K
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…	10,340	$80	$827.4K

Showing 1–10 of 254

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

Covenant Medical Center Inc — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

254 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	3	70	1,440	$90	$2.8M
41874	Alveoloplasty is done prior to placement of a dental prosthesis. In order to facilitate smooth fitting of the denture, the dentist performs alveoloplasty to make the alveolar process smoother.…	1	10	460	$2,050	$936.9K
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.	22	280	850	$140	$801.8K
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.	39	180	340	$170	$722K
J0585	Injection, onabotulinumtoxina, 1 unit	14	20	380	$700	$687.3K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	9	60	2,110	$70	$570.5K
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.	24	310	1,320	$100	$543.4K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	4	10	2,020	$140	$527.6K
G0330	Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an…	4	10	110	$2,080	$475.6K
H0035	Mental health partial hospitalization, treatment, less than 24 hours	9	10	920	$150	$420.1K

Showing 1–10 of 254

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Covenant Medical Center Inc	IA	Family Medicine Physician	$0	$21.9M
Covenant Medical Center Inc	IA	Durable Medical Equipment & Medical Supplies	$0	$2.1M
Jay Robinow	KS	Radiation Oncology Physician	$1.2M	$0
Andrew Pugely	IA	Orthopaedic Surgery of the Spine Physician	$327.4K	$0
Ahsan Maqsood	IA	Interventional Cardiology Physician	$324.4K	$0
Victor Abrich	IA	Clinical Cardiac Electrophysiology Physician	$213.3K	$0
Ravinder Dervesh	IA	Interventional Cardiology Physician	$196.9K	$0
Brendan Coutu	IA	Radiation Oncology Physician	$193.3K	$0
Richard Valente	IA	Cardiovascular Disease Physician	$182.1K	$0
Cristina Pasarin	IA	Nephrology Physician	$177K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Black Hawk-grundy Mental Health Center Inc.	IA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$20.7M
Waterloo Community School District	IA	Local Education Agency (LEA)	$0	$19.8M
Iowa Emergency Physicians LLP	IA	Emergency Medicine Physician	$0	$5.1M
Jyoti Chowdhury	IA	Pediatric Dentistry	$0	$2.4M
Michael Letkewicz	IA	Oral and Maxillofacial Surgery (Dentist)	$0	$1.7M
Metropolitan Transit Authority Of Black Hawk County	IA	Bus	$0	$1.7M
Michael Puk	IA	Ophthalmology Physician	$1.6M	$0
Carol Halloran	IA	Dentist	$0	$1.6M
Panther Ventures LLC	IA	Non-emergency Medical Transport (VAN)	$0	$1.3M
Thomas Petrie	IA	Ophthalmology Physician	$1.2M	$330

Covenant Medical Center Inc — 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