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

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

Madison Primary Care, LLC (NPI 1730473745)

Madison Primary Care, LLC is a rural health clinic/center provider located in Richmond, Kentucky. This profile covers 0 Medicare and 18 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	Madison Primary Care, LLC
Address	210 Saint George St
City	Richmond
State	KY
ZIP	40475
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	June 7, 2011

Payer Source	Total Paid
Medicaid	$2.9M
Medicare	$0

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

18 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…	60,260	$30	$1.9M
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	27,250	$30	$762.9K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	950	$70	$66.4K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	540	$60	$30.5K
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…	430	$50	$21.3K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	370	$40	$15.7K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	780	$20	$12.4K
93923	Noninvasive arterial diagnostic procedures are performed to examine the rate of blood flow in an area and to assess the presence of a blockage in the upper and lower extremity arteries.…	220	$40	$9.5K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	540	$20	$9.1K
95923	In this procedure, the provider tests the sudomotor function of the autonomic nervous system to check functioning of nerves that supply sweat glands. The autonomic nervous system is that part of the…	120	$50	$5.8K

Showing 1–10 of 18

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Madison Primary Care, LLC — 3 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

18 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	727	1,270	760	$80	$447.2K
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…	90	3,340	1,020	$30	$296K
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…	1,355	2,460	580	$40	$245K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	28	600	600	$40	$207.8K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	227	500	250	$60	$152.8K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	129	290	670	$20	$103.8K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	226	260	230	$90	$84.9K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	119	680	130	$80	$62.9K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	416	870	480	$20	$61.8K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	832	1,450	270	$30	$61K

Showing 1–10 of 18

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
American Health Management, Inc.	KY	Adult Day Care Clinic/Center	$0	$99.1M
Baptist Healthcare System, Inc.	KY	General Acute Care Hospital	$0	$58.5M
Fm Healing Center, LLC	KY	Addiction Medicine (Family Medicine) Physician	$0	$22M
Quality Care Case Management, LLC.	KY	Case Management Agency	$0	$17.5M
Nathaniel House, Inc.	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$14.4M
Ethan Health LLC	KY	Substance Abuse Rehabilitation Facility	$0	$13.1M
Combined Physicians Lab LLC	KY	Clinical Medical Laboratory	$428.1K	$7.4M
Center For Behavioral Health Kentucky LLC	KY	Methadone Clinic	$198.1K	$7.2M
Bluegrass Pediatric Therapies, LLC	KY	Speech-Language Pathologist	$0	$4.5M
Madison Pediatric Assoc	KY	Pediatrics Physician	$0	$3.9M

Madison Primary Care, LLC — Billing Profile & Reimbursement Data

Sign up for Madison Primary Care, LLC — Billing Profile & Reimbursement Data policy alerts

Madison Primary Care, LLC — Billing Profile & Reimbursement Data

Sign up for Madison Primary Care, LLC — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References