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

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

The Metrohealth System (NPI 1700828852)

Field	Value
Entity Type	Organization
Organization	The Metrohealth System
Address	2500 Metrohealth Dr
City	Cleveland
State	OH
ZIP	44109
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 12, 2006

Payer Source	Total Paid
Medicaid	$574.3M
Medicare	$0

Key Findings

THE METROHEALTH SYSTEM appears effectively single-payer in the available federal data: there is no Medicare billing on file while Medicaid billing totals $574.3M, so all reported federal reimbursements in this dataset are concentrated in Medicaid. Analysts should treat conclusions about commercial or Medicare mix as not observable from these files and focus competitive conclusions at the state Medicaid level.

Revenue is highly concentrated in a very small set of procedure codes: the precomputed top three Medicaid codes account for 68.9% of the provider's total Medicaid revenue. Those top three are G0463 ($234.3M, 55.2% of Medicaid revenue), 99285 ($30.4M, 7.2%), and 99284 ($27.7M, 6.5%), making outpatient clinic assessment visits and high/moderate emergency department E/M the primary revenue drivers.

G0463 dominates the Medicaid footprint: 2.1M claims generating $234.3M and accounting for 55.2% of Medicaid revenue, and the provider ranks #2 of 151 in-state (99th percentile, described as an extreme outlier). This pattern indicates a very large hospital outpatient clinic operation or consolidated ambulatory intake mechanism that is far above typical state volume for that service.

Emergency care is a major service line: 99285, 99284, and 99283 together represent high volumes (165.5K, 184.5K, and 158.6K claims respectively) and meaningful shares of Medicaid revenue (7.2%, 6.5%, and 4.9%). Each of these ED E/M codes ranks in the top decile statewide (7th–9th ranks with 98th–99th percentiles and labeled extreme outliers), supporting the conclusion that MetroHealth sustains unusually high ED throughput relative to peers.

The provider shows breadth across outpatient and ambulatory specialty services beyond ED work: large preventive and well-visit codes (99392, 99391, 99393, 99394, 99395) and ophthalmology 92014 (72.5K claims, $5.9M revenue, rank #1 of 1074, 100th percentile) indicate sizable pediatric/primary-care and specialty clinic activity. Massive lab volume on 80048 (423.8K claims, $4.2M revenue, rank #2 of 232, 100th percentile) further signals centralized diagnostic capacity that supports a high outpatient case mix.

Behavioral health and substance-use services are visible at scale: 90791 (26.8K claims, $6.1M, rank #2 of 1263, 100th percentile) and 90834 (30.6K claims, $4.1M, 98th percentile) plus H0015 (22.3K claims, $3.2M, 86th percentile) indicate integrated psychiatric evaluation, psychotherapy, and intensive outpatient substance-use treatment programs. The high ranks and percentile labels (many described as extreme outliers or notably above typical) imply these are important, high-volume service lines in the Medicaid population.

There is evidence of specialized/high-cost services alongside high-volume general care: J9271 (pembrolizumab) accounts for $6.8M on 1K claims with a very high avg paid/claim ($6680) but ranks #5 of 22 in-state and is described as typical/unremarkable for that code; polysomnography (95810) and advanced imaging (74177, 70450) also appear among the top codes. This mix suggests the system operates both high-throughput ambulatory/ED platforms and some specialty/oncology or diagnostic capabilities, though the high-cost drug is not a statewide outlier.

MetroHealth is a long-tenured filer in federal registries (NPI enumerated 2006-06-12, ~20 years ago) and is a dominant Medicaid competitor in multiple service lines at the state level. Multiple top codes rank in the 99th–100th percentiles or are labeled extreme outliers (including a #1 rank for 92014 and a #2 rank for G0463), which positions the system as a major in-state Medicaid provider with concentrated revenue in outpatient clinic visits and emergency department services.

Medicaid: Complete Services Breakdown

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

1117 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	2,149,200	$110	$234.3M
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.	165,460	$180	$30.4M
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.	184,480	$150	$27.7M
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.	158,590	$130	$20.6M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	47,680	$320	$15.2M
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…	62,120	$120	$7.4M
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…	58,860	$120	$6.8M
J9271	Injection, pembrolizumab, 1 mg	1,010	$6,680	$6.8M
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…	80,480	$80	$6.7M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	26,830	$230	$6.1M

Showing 1–10 of 1117

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

The Metrohealth System — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

1117 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	2	150	4,030	$100	$5.9M
J9271	Injection, pembrolizumab, 1 mg	5	20	360	$8,480	$5M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	4	170	4,660	$300	$2.6M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	87	610	1,350	$150	$1.9M
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.	9	480	4,510	$90	$1.8M
H2019	Therapeutic behavioral services, per 15 minutes	130	840	240	$90	$1.8M
J0741	Injection, cabotegravir and rilpivirine, 2mg/3mg	4	10	230	$4,830	$1.7M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	4	20	480	$730	$1.6M
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.	8	660	460	$90	$1.5M
J0178	Injection, aflibercept, 1 mg	17	20	310	$1,070	$1.4M

Showing 1–10 of 1117

Related Providers

Other providers that share a Tax Identification Number (TIN) with The Metrohealth System, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Metrohealth System	OH	Multi-Specialty Clinic/Center	$0	$125.4M
The Metrohealth System	OH	Air Ambulance	$0	$27.3M
The Metrohealth System	OH	Dentist	$0	$7.8M
Syed Akbar	IL	Diagnostic Radiology Physician	$280.8K	$223.7K
Alex Yuan	OH	Ophthalmology Physician	$471.3K	$0
Steven Benedict	OH	Neurology Physician	$347.4K	$0
Chad Marcantonio	OH	Ophthalmology Physician	$310.9K	$0
Andrea Natale	TX	Clinical Cardiac Electrophysiology Physician	$309.4K	$0
Edward Barton	CA	Neurology Physician	$260.1K	$0
The Metrohealth System	OH	Community/Retail Pharmacy	$242K	$50

Nearby Providers

Other providers in the same ZIP code as The Metrohealth System, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ohio Renal Care Group, LLC	OH	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$7M
Raj Vallabhaneni	OH	Interventional Cardiology Physician	$187.7K	$0
Stephen Scull	OH	Emergency Medicine Physician	$83.8K	$42K
Bryan Canterbury	OH	Emergency Medicine Physician	$106.8K	$0
Ann Rivera	OH	Diagnostic Radiology Physician	$73.3K	$8.1K
Aleksandr Rovner	OH	Cardiovascular Disease Physician	$79.7K	$30
Kevin Casebolt	OH	Emergency Medicine Physician	$77.3K	$0
Aurelia Cheng	OH	Emergency Medicine Physician	$75.2K	$0
Laila Shiekh Sroujieh	OH	Internal Medicine Physician	$73.7K	$0
Sean Nagel	OH	Neurological Surgery Physician	$72.2K	$0

The Metrohealth System — Billing Profile & Reimbursement Data

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The Metrohealth System — 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