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

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

Ssm Medical Group, Inc. (NPI 1700966207)

Ssm Medical Group, Inc. is a multi-specialty clinic/center provider located in Fenton, Missouri. This profile covers 0 Medicare and 143 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	Ssm Medical Group, Inc.
Address	1011 Bowles Ave
City	Fenton
State	MO
ZIP	63026
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	October 17, 2006

Payer Source	Total Paid
Medicaid	$19.4M
Medicare	$0

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

143 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…	119,650	$60	$7.3M
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…	55,780	$70	$3.7M
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…	15,010	$90	$1.4M
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…	14,330	$90	$1.3M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7,940	$100	$761.9K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	25,720	$30	$720.3K
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…	7,960	$80	$629.1K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	12,960	$40	$531.2K
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…	2,660	$110	$297.8K
90698	This code represents a combination vaccine product administered into the muscle to protect against five diseases: diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), and polio.	8,750	$30	$288.7K

Showing 1–10 of 143

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

Ssm Medical Group, Inc. — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

143 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	119	320	980	$40	$352.7K
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.	1,014	1,260	220	$120	$242.4K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	15	20	30	$450	$147.8K
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.	16	90	120	$250	$141.3K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	8	30	90	$340	$140.3K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	30	30	50	$650	$137.5K
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…	4	3,170	230	$70	$128.1K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	16	590	260	$40	$120.5K
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…	21	4,310	300	$60	$110.8K
93325	The provider performs Doppler echocardiography, a diagnostic procedure based on the Doppler effect of sound, color flow velocity mapping, a two–dimensional image representation of blood flow in the…	67	70	440	$60	$90K

Showing 1–10 of 143

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ssm Cardinal Glennon Children's Hospital	MO	Children's Hospital	$0	$52.6M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$50.1M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$27.7M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$12.4M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$8.9M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$7.7M
Ssm Cardinal Glennon Childrens Hospital	IL	Pediatrics Physician	$0	$5.4M
Rotimi Johnson	IL	Vascular & Interventional Radiology Physician	$624.3K	$1.1K
Shamseldeen Mahmoud	MO	Neuroradiology Physician	$109.5K	$474K
Paul Hinton	MO	Internal Medicine Physician	$369.6K	$166.4K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thyroid Specialty Laboratory Inc	MO	Clinical Medical Laboratory	$3.2M	$30.2M
Option Care Enterprises, Inc.	MO	Home Infusion Therapy Pharmacy	$0	$11.2M
Alternative Hospice LLC	MO	Community Based Hospice Care Agency	$0	$4.1M
Solutions Lab And Health Care Services LLC	MO	Clinical Medical Laboratory	$967.7K	$1.4M
Jeffrey Petersen	MO	Dermatology Physician	$616.1K	$0
Fenton Fire Protection District	MO	Land Ambulance	$291.6K	$304.6K
Ssm St Clare Surgical Center LLC	MO	Ambulatory Surgical Clinic/Center	$398K	$0
Brent Davidson	MO	Ophthalmology Physician	$251.9K	$0
Michael Boedefeld	MO	Pain Medicine (Anesthesiology) Physician	$176.7K	$4.2K
Adam Shomstein	MO	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$150.8K	$0

Ssm Medical Group, Inc. — 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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