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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

University Physicians & Surgeons, Inc (NPI 1730183286)

Key Findings

Field	Value
Entity Type	Organization
Organization	University Physicians & Surgeons, Inc
Address	1600 Medical Center Drive
City	Huntington
State	WV
ZIP	25701
Taxonomy	Internal Medicine Physician
NPI Enumerated	June 10, 2005

Payer Source	Total Paid
Medicaid	$58.3M
Medicare	$0

UNIVERSITY PHYSICIANS & SURGEONS, INC shows essentially single-payer activity: there is no Medicare billing on file while the provider reports $58.3M in lifetime Medicaid revenue, indicating Medicaid is the sole recorded government payer in the dataset and the primary source of public-payer volume for this entity. This concentration implies the practice’s financial exposure and contracting strategy are heavily tied to Medicaid reimbursement and population served.

Revenue concentration is high within Medicaid: the top three Medicaid CPT/HCPCS codes by revenue (99213, 99214, 99232) together account for 59.9% of the provider’s total Medicaid revenue. That concentration signals that routine evaluation-and-management (E/M) office visits and inpatient follow-up visits are the dominant revenue drivers for this provider.

The code mix indicates an internal medicine–oriented primary care and inpatient continuity operation: high-volume E/M office visit codes 99213 (29.4% of Medicaid revenue) and 99214 (21.7%) dominate, supplemented by inpatient subsequent care 99232 (8.8%). This pattern is consistent with a high-throughput ambulatory clinic that also manages substantial inpatient follow-up or hospital-based continuity of care.

Competitive standing within the state is unusually strong: 99213 ranks #2 of 1273 providers and 99214 ranks #3 of 1031 providers in-state, both at the 100th percentile and labeled extreme outliers. Multiple other E/M and preventive codes (for example 99392 and 99391) also sit at the 100th percentile or near it, showing the provider is a major, high-volume Medicaid participant statewide for core primary care services.

Several procedural and ancillary service codes are also notable and indicate breadth of services beyond standard office visits: pathology codes 88305 and 88307, dental extraction and restorative codes D7210 and D2392, and high-volume vaccine administration codes 90471 and 90472 all appear among the top-billed Medicaid codes. Many of these codes rank in the top state percentiles (often 98–100th) which suggests the organization either operates or is closely affiliated with broader outpatient procedural, dental, lab, and preventive service lines.

The provider’s state-level ranking includes multiple labeled statistical outliers and notably above-typical volumes: several entries are marked as "extreme outlier" or "notably above typical state volume," which reinforces that for many individual codes this provider’s Medicaid activity is far above typical in-state peers rather than merely modestly larger. Analysts should interpret these designations as indicators of disproportionate share for those service lines within the state.

Tenure is long: the provider’s NPI was enumerated on 2005-06-10 (~21 years ago), indicating an established presence and multi-year operational history in the market that could explain its accumulation of high volumes and broad service mix. This longevity supports the plausibility of sustained high Medicaid throughput rather than a short-term spike.

Clinical mix includes both preventive and complex inpatient services: high-volume preventive medicine codes (99392 ranked #1 and 99391 ranked #1 in-state) coexist with higher-complexity inpatient E/M codes such as 99223 and 99233 (ranked at high percentiles). That combination suggests the provider delivers both routine well-care and higher-acuity inpatient management, consistent with a system-affiliated or multi-site practice serving diverse patient needs.

Medicaid: Complete Services Breakdown

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

412 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	284,430	$50	$13.4M
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…	151,930	$70	$9.9M
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…	94,750	$40	$4M
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…	21,130	$100	$2M
99203	The provider sees a new 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 provider…	24,650	$60	$1.6M
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	14,000	$100	$1.4M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	17,680	$60	$1.1M
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	27,850	$40	$1.1M
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…	14,300	$70	$1M
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	12,680	$80	$976.4K

Showing 1–10 of 412

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

University Physicians & Surgeons, Inc — 21 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

412 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.	128	170	3,350	$120	$1.1M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	3	10	3,780	$250	$1.1M
J0585	Injection, onabotulinumtoxina, 1 unit	3	10	2,680	$320	$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.	119	160	3,690	$80	$714.8K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	3	10	940	$260	$683.6K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	3	10	7,500	$100	$617.9K
T1016	Case management, each 15 minutes	79	100	2,790	$90	$496.2K
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	29	30	1,020	$50	$438.2K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	3	10	3,270	$90	$365.7K
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.	66	110	5,530	$20	$344.8K

Showing 1–10 of 412

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Pediatric Associates, Inc.	IN	Pediatrics Physician	$0	$98.3M
University Physicians & Surgeons, Inc.	WV	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$9.4M
William Myer	WV	Oral and Maxillofacial Surgery (Dentist)	$0	$774.1K
Vishal Verma	WV	Ophthalmology Physician	$419.8K	$0
Robin Arora	WV	Nephrology Physician	$392.5K	$0
Jonathan Cuda	TN	Anatomic Pathology Physician	$326.7K	$0
Rabah Boukhemis	WV	Physical Medicine & Rehabilitation Physician	$210.6K	$0
Matthew Bullock	WV	Adult Reconstructive Orthopaedic Surgery Physician	$207.9K	$0
Cynthia Pinson	WV	Family Medicine Physician	$206.4K	$0
Alexander Caughran	WV	Orthopaedic Surgery Physician	$175.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cabell Huntington Hospital Inc	WV	General Acute Care Hospital	$0	$94.1M
Autism Service Center	WV	Developmental Disabilities Clinic/Center	$0	$59M
Tri-state Addiction Recovery Resources	WV	Community/Behavioral Health Agency	$0	$29.6M
County Of Cabell	WV	Land Ambulance	$2.6M	$23.3M
Ohio Valley Physicians Inc	WV	Community/Behavioral Health Agency	$0	$22.8M
Huntington Treatment Center, LLC	WV	Methadone Clinic	$0	$21M
Valley Health Systems Inc	WV	Federally Qualified Health Center (FQHC)	$0	$13.4M
Valley Health Systems Inc	WV	Federally Qualified Health Center (FQHC)	$0	$10.2M
Valley Health Systems Inc	WV	Federally Qualified Health Center (FQHC)	$0	$10.1M
Cabell Huntington Hospital Inc	WV	General Acute Care Hospital	$0	$9.3M

University Physicians & Surgeons, 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