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.

Memorial Hermann Health System (NPI 1730132234)

Key Findings

Field	Value
Entity Type	Organization
Organization	Memorial Hermann Health System
Address	1635 North Loop W
City	Houston
State	TX
ZIP	77008
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 18, 2006

Payer Source	Total Paid
Medicaid	$84.4M
Medicare	$0

MEMORIAL HERMANN HEALTH SYSTEM is effectively a Medicaid-focused billing entity in the dataset: there is no Medicare revenue on file while Medicaid revenue totals $84.4M, making this profile single-payer in practice for the available claims data. Analysts should treat Medicare-based benchmarks as not applicable for this provider and focus competitive comparisons within Texas Medicaid activity.

Revenue concentration is high: the top three Medicaid codes by revenue account for 76.9% of this provider's total Medicaid revenue, indicating a small set of services—chiefly emergency department E/M visits—drive the majority of payments. This concentration suggests the provider’s Medicaid financial performance is sensitive to volume and price changes for those primary codes.

Emergency department evaluation-and-management codes dominate the Medicaid mix. Code 99284 accounts for $44.3M (54.7% of Medicaid revenue) with 87.6K claims, and 99285 and 99283 add $9.6M (11.8%) and $8.5M (10.5%) respectively; together these three ED codes explain the precomputed 76.9% share. This pattern indicates MEMORIAL HERMANN operates high-volume ED services for Medicaid patients and that ED throughput and acuity mix are central to its Medicaid business line.

Competitive standing on key ED codes is strong statewide: 99284 ranks #17 of 714 providers (98th percentile) and 99283 ranks #20 of 732 providers (97th percentile), both described as notably above typical state volume; 99285 ranks #38 of 587 providers (94th percentile) and is described as typical. Collectively, these ranks position the system as a major emergency-care provider for Medicaid enrollees in Texas, particularly for moderately complex ED visits.

Beyond ED services, several ancillary hospital services are extreme or notable outliers in Texas Medicaid volume. Codes such as 93005 (ECG technical only) rank #3 of 308 providers (99th percentile, labeled an extreme outlier), 87635 (SARS–CoV–2 NAAT) ranks #5 of 846 providers (100th percentile, extreme outlier), and 80048/84484/83690 each rank in high percentiles (98–99th) as extreme outliers. These high volumes among laboratory and diagnostic codes are consistent with large emergency and inpatient throughput supporting broad ancillary testing.

Clinical-service mix reflects acute inpatient/ED-centered operations: the top codes are ED E/Ms, broad laboratory panels (80053, 80048, 80076), CBC (85025), imaging (71045, 70450, 74177), and cardiac/ECG services (93005, 84484). This combination signals an acute care hospital with high diagnostic and imaging utilization tied to its emergency and acute medical caseloads rather than elective outpatient procedures.

Tenure in the NPI registry indicates long-standing presence: the provider’s NPI was enumerated on 2006-05-18 (~20 years ago), supporting that these patterns reflect an established health system with sustained Medicaid engagement rather than a newly created billing entity. Analysts should consider institutional scale and legacy referral patterns when interpreting volumes.

The revenue mix and code-level ranks imply operational risk/opportunity concentration around ED flow and test utilization: with over three-quarters of Medicaid revenue coming from three ED codes, policy, reimbursement changes, or shifts in local ED demand could materially impact the provider’s Medicaid revenue. Conversely, payers looking to manage costs or direct care differently will find substantial leverage by targeting ED utilization, ancillary testing, and related protocols.

Medicaid: Complete Services Breakdown

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

223 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	87,610	$510	$44.3M
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.	20,720	$460	$9.6M
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.	69,460	$120	$8.5M
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	48,930	$50	$2.5M
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…	103,590	$20	$2.4M
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	22,870	$90	$2.1M
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	41,470	$50	$2M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	36,400	$40	$1.5M
81001	Urinalysis is used to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is used to detect urinary tract infections (UTI) and other…	64,380	$20	$1.5M
80048	The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood…	37,150	$30	$1.2M

Showing 1–10 of 223

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

Memorial Hermann Health System — 15 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

223 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.	17	710	1,790	$200	$2.1M
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.	20	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.	38	590	740	$170	$969.2K
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…	1,078	1,350	1,860	$80	$872.4K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	124	340	400	$50	$553.5K
G0378	Hospital observation service, per hour	21	70	300	$500	$465K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	283	1,620	1,070	$70	$333.5K
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.	82	370	360	$120	$279.5K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	203	370	550	$80	$249.6K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	107	160	350	$110	$230.4K

Showing 1–10 of 223

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kids Home Care Of Texas, Inc	TX	Home Health Agency	$0	$33.7M
Valley View Primary Home Care	TX	Personal Care Attendant	$0	$26.5M
Gene By Gene Ltd	TX	Clinical Medical Laboratory	$2.2M	$9.2M
Tejas Desai	TX	Dermatology Physician	$2.2M	$0
Alpesh Desai	TX	Dermatology Physician	$1.8M	$0
Heights Surgery Center, Inc.	TX	Ambulatory Surgical Clinic/Center	$664.2K	$0
Wajeeha Yousaf	TX	Rheumatology Physician	$644.8K	$0
Amit Sharma	TX	Vascular & Interventional Radiology Physician	$469.7K	$0
Jeremy Bourgeois	TX	Physical Therapist	$266.9K	$0
Us Lab Holdings LLC	TX	Clinical Medical Laboratory	$255K	$410

Memorial Hermann Health System — Billing Profile & Reimbursement Data

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Memorial Hermann Health 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Memorial Hermann Health System	TX	General Acute Care Hospital	$0	$39.5M
Memorial Hermann Health System	TX	General Acute Care Hospital	$0	$26.8M
Conroe Surgery Center 2, LLC	TX	Ambulatory Surgical Clinic/Center	$2M	$0
Memorial Hermann Surgery Center Sugar Land LLP	TX	Ambulatory Surgical Clinic/Center	$1.8M	$0
Memorial Hermann Surgery Center Preston Road, Ltd.	TX	Ambulatory Surgical Clinic/Center	$1.7M	$1.3K
Memorial Hermann Surgery Center Kirby, LLC	TX	Ambulatory Surgical Clinic/Center	$1.6M	$0
Physicians West Houston Surgical Center, LLC	TX	Ambulatory Surgical Clinic/Center	$1.3M	$0
Memorial Hermann Surgery Center Woodlands Parkway, LLC	TX	Ambulatory Surgical Clinic/Center	$1.2M	$0
Memorial Hermann Surgery Center Southwest LLP	TX	Ambulatory Surgical Clinic/Center	$1.2M	$27K
Sugar Land Cardiovascular Asc LLC	TX	Ambulatory Surgical Clinic/Center	$1M	$0