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

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

Children's Health System Of Texas (NPI 1720480627)

Key Findings

Field	Value
Entity Type	Organization
Organization	Children's Health System Of Texas
Address	7601 Preston Rd
City	Plano
State	TX
ZIP	75024
Taxonomy	Children's Hospital
NPI Enumerated	September 23, 2014

Payer Source	Total Paid
Medicaid	$65.8M
Medicare	$0

CHILDREN'S HEALTH SYSTEM OF TEXAS is effectively a single-payer (Medicaid-focused) provider: there is no Medicare billing on file and total Medicaid revenue is $65.8M, indicating the organization’s scale and reimbursement exposure is concentrated in the Medicaid population rather than mixed Medicare/Medicaid flows. This profile should be treated as Medicaid-dominant for payer-mix analysis and network negotiations.

Revenue concentration is high: the precomputed top three Medicaid codes account for 64.7% of the provider’s Medicaid revenue, driven by 99283 ($22.7M, 35.7%), 99284 ($12M, 18.8%), and 95782 ($6.5M, 10.2%). This concentration implies that a small set of service lines (emergency department E/M and attended pediatric sleep studies) drive the majority of billing and financial performance.

Emergency department E/M services are the primary revenue engine: 99283 alone generates $22.7M (35.7% of Medicaid revenue) and 99284 contributes $12M (18.8%), with additional support from 99282 ($4.3M, 6.7%) and 99285 ($1.1M, 1.8%). The code mix and dollar volumes indicate a high-volume pediatric emergency and urgent-care operation that likely supports downstream diagnostics and procedures on site.

The provider shows a substantive pediatric sleep medicine footprint: attended sleep study 95782 accounts for $6.5M (10.2%) and polysomnography 95810 adds $5.8M (9.2%), with strong in-state ranks (95782 ranks #4 of 26; 95810 ranks #6 of 64). These figures signal a dedicated sleep lab capability that is a material service line for this children’s hospital.

Competitive standing in key service lines is uneven but notable: for ED E/M, 99283 ranks #39 of 732 in-state (95th percentile) and 99282 ranks #12 of 368 (97th percentile), both described as “notably above typical” state volume, indicating the provider is a major pediatric ED participant locally. By contrast, higher-acuity ED code 99285 ranks more modestly (#232 of 587, 61st percentile), suggesting the center sees a larger share of low-to-moderate acuity visits relative to the highest-acuity ED encounters.

The provider is an outlier for proprietary respiratory panel testing: 0202U appears as an extreme outlier with 23.2K claims, $53 avg paid/claim, $1.2M revenue and ranks #1 of 66 in-state (100th percentile). Coupled with substantial counts for other lab/testing codes (e.g., U0002 3.7K claims, $271.4K revenue; 87636 1.5K claims, $224.8K revenue), this suggests a high-volume on-site diagnostic testing capacity that supports respiratory pathogen surveillance and ED throughput.

Surgical and procedural pediatric services are present but secondary in revenue: tonsil/adenoid removal 42820 ($1.7M, 2.7%), tympanostomy 69436 ($1.6M, 2.5%), and strabismus surgery 67311 ($1.1M, 1.8%) indicate active ENT and ophthalmologic procedure lines typical of a children’s hospital. These procedure volumes, while smaller than the ED and sleep lines, reflect a broad service mix that includes ambulatory pediatric surgeries.

NPI tenure and operational history are established: the provider’s NPI was enumerated 2014-09-23 (~12 years ago), indicating about a decade-plus of billing history under this identifier. That tenure supports treating observed patterns (high ED volume, dedicated sleep lab, and extensive on-site testing) as stable elements of this provider’s business profile rather than transient anomalies.

Medicaid: Complete Services Breakdown

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

115 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	49,020	$460	$22.7M
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.	13,270	$900	$12M
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	1,810	$3,590	$6.5M
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	2,340	$2,500	$5.8M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	16,270	$260	$4.3M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	540	$3,150	$1.7M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	1,080	$1,470	$1.6M
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	23,160	$50	$1.2M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	900	$1,360	$1.2M
67311	The provider realigns an imbalance in the eye muscles by either recession, which weakens the eye muscle or resection, which strengthens the muscles so as to restore normal vision. This procedure is…	420	$2,710	$1.1M

Showing 1–10 of 115

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Texas Distribution

Children's Health System Of Texas — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. Texas median

115 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	138	710	1,790	$200	$2.1M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	20	70	370	$760	$1M
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.	39	730	1,960	$100	$1M
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.	232	590	740	$170	$969.2K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	4	30	330	$1,020	$750.2K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	6	60	340	$590	$491.5K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	17	110	80	$1,260	$398.1K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	24	160	200	$110	$323.8K
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	62	160	200	$280	$321.8K
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	96	150	170	$30	$302.9K

Showing 1–10 of 115

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Center For Autism And Related Disorders LLC	TX	Behavior Analyst	$0	$73M
Nys Home Health, LLC	TX	Home Health Agency	$0	$11.1M
Delta Laboratories LLC	TX	Clinical Medical Laboratory	$4.7M	$690.5K
Joel Lurie	TX	Nurse Practitioner	$2.8M	$0
Hemang Pandya	TX	Retina Specialist (Ophthalmology) Physician	$1.1M	$0
Matthew Adams	TX	Retina Specialist (Ophthalmology) Physician	$873.3K	$0
Medi-lynx Cardiac Monitoring LLC	TX	Physiological Laboratory	$4.4K	$741.4K
Andrew Binder	TX	Cardiovascular Disease Physician	$677.6K	$0
Jose Rivera	TX	Cardiovascular Disease Physician	$646.5K	$0
Hao-yu Ren	TX	Cardiovascular Disease Physician	$546.6K	$0

Children's Health System Of Texas — Billing Profile & Reimbursement Data

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Children's Health System Of Texas — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Health System Of Texas	TX	Children's Hospital	$0	$263.9M
Marilee Owens	HI	Family Nurse Practitioner	$6.3K	$0