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

Why is the Medicaid comparison limited to Wisconsin 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. Wisconsin (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 Hospital Of Wisconsin, Inc. (NPI 1750482022)

Field	Value
Entity Type	Organization
Organization	Children's Hospital Of Wisconsin, Inc.
Address	9000 W Wisconsin Ave
City	Milwaukee
State	WI
ZIP	53226
Taxonomy	Children's Hospital
NPI Enumerated	September 26, 2006

Payer Source	Total Paid
Medicaid	$262.3M
Medicare	$0

Key Findings

CHILDREN'S HOSPITAL OF WISCONSIN, INC. reports no Medicare billing on file and $262.3M in lifetime Medicaid revenue, making it effectively a Medicaid-dominant provider in the available data. The absence of Medicare revenue means analyses of this entity should treat Medicaid as the primary payer when assessing financial exposure and utilization patterns.

Revenue is highly concentrated in a few outpatient E/M codes: the precomputed top three Medicaid codes (99213, 99283, 99212) together account for 45.7% of the provider's total Medicaid revenue. Those individual contributions are 99213 ($38.4M, 24.5%), 99283 ($18.3M, 11.7%), and 99212 ($14.9M, 9.5%), indicating substantial dependence on high-volume clinic and emergency department encounters.

The code mix indicates a full-service pediatric hospital with heavy outpatient and emergency care throughput plus broad ancillary services. High volumes of E/M codes (99213, 99212, 99214, 99215, 99282–99284) alongside lab codes (80053), multiplex respiratory testing (87637, 87635), pediatric echocardiography (93303), dental care (D0120, 41899, D2930), surgical tonsil/adenoid procedures (42820), and therapy codes (, ) point to integrated clinical, diagnostic, surgical, dental, and rehabilitation capacity oriented to children.

On competitive standing within the state, the provider appears dominant for many pediatric service lines: 99213 ranks #2 of 1755 providers in-state (100th percentile; extreme outlier), 99212 ranks #1 of 687 (100th percentile; extreme outlier), and 99283 ranks #2 of 362 (100th percentile; extreme outlier). These rankings show the hospital operates at volumes far above typical state peers for core outpatient and ED pediatric E/M services.

Dental and pediatric procedural services are also a statewide outlier, supporting a specialty service footprint beyond routine clinic visits. Examples include D0120 (59.7K claims, $5.6M revenue) at rank #2 of 502 providers (100th percentile; extreme outlier), 41899 ($3.3M revenue) at rank #1 of 36 providers (100th percentile; extreme outlier), and 42820 ($3.1M revenue) at rank #1 of 20 providers (100th percentile; extreme outlier), which together indicate unusually large pediatric dental and operative case volumes.

Rehabilitation and diagnostic testing are material ancillary revenue drivers and show outsized state-level activity. Therapeutic exercise 97110 (80.5K claims, $4.3M revenue) ranks #4 of 631 (100th percentile; extreme outlier) and neuromuscular reeducation 97112 (65.3K claims, $2.8M revenue) ranks #1 of 221 (100th percentile; extreme outlier), while multiplex respiratory testing 87637 (23.5K claims, $3.6M revenue) ranks #2 of 77 (99th percentile; extreme outlier), signaling large-scale rehab and infectious-disease testing throughput.

The provider also generates meaningful Medicaid revenue from infusion, blood products, and observation services that support complex pediatric care pathways. Notable items include P9016 (4.9K claims, $3.4M revenue) at rank #1 of 10 providers (100th percentile; notably above typical state volume), G0378 ($2.6M revenue) at rank #5 of 96 providers (96th percentile; notably above typical), and 96365 ($2.6M revenue) at rank #4 of 135 providers (98th percentile; notably above typical), which together suggest capacity for inpatient/observation and outpatient infusion services.

The NPI was enumerated on 2006-09-26 (~20 years ago), indicating long tenure in the market; this longevity combined with the facility’s extreme-volume ranks implies an established referral base and operational scale. Analysts should consider this sustained presence when evaluating contracting leverage, access footprint, and the potential impact of shifts in pediatric Medicaid utilization.

Medicaid: Complete Services Breakdown

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

781 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…	355,640	$110	$38.4M
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.	180,910	$100	$18.3M
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,…	143,010	$100	$14.9M
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…	100,860	$110	$10.9M
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.	85,830	$100	$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.	65,160	$90	$5.7M
D0120	Periodic oral evaluation - established patient	59,740	$90	$5.6M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	38,930	$140	$5.4M
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.	43,170	$100	$4.4M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	80,500	$50	$4.3M

Showing 1–10 of 781

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Children's Hospital Of Wisconsin, Inc. — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

781 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
95715	The patient undergoes electroencephalography, a study of the electrical activity of the brain, lasting 12 to 26 hours with intermittent monitoring and maintenance. A video recording is made, and an…	2	10	5,510	$300	$1.6M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	27	140	3,200	$160	$1.1M
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	6	20	760	$110	$1M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	4	10	2,330	$400	$916.4K
P9016	Red blood cells, leukocytes reduced, each unit	1	10	750	$590	$906.4K
D8670	N/A	22	80	2,010	$110	$635.7K
J0588	Injection, incobotulinumtoxin a, 1 unit	4	10	1,370	$280	$624.7K
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.	2	360	1,550	$70	$614.4K
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	430	760	$60	$484.6K
44970	Laparoscopy, surgical, appendectomy	1	10	320	$1,470	$466.1K

Showing 1–10 of 781

Related Providers

Other providers that share a Tax Identification Number (TIN) with Children's Hospital Of Wisconsin, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Childrens Hospital Of Wisconsin, Inc.	WI	Pediatrics Physician	$0	$19M
Children's Hospital And Health System, Inc.	WI	Urgent Care Clinic/Center	$0	$17.7M
Children's Hospital Of Wisconsin, Inc.	WI	Children's Hospital	$0	$3.4M
Sara Schaetzka	WI	Audiologist	$5.5K	$0

Nearby Providers

Other providers in the same ZIP code as Children's Hospital Of Wisconsin, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Froedtert Memorial Lutheran Hospital, Inc.	WI	General Acute Care Hospital	$0	$157.8M
The Medical College Of Wisconsin, Inc.	WI	Internal Medicine Physician	$17.8K	$74.8M
Emergency Medicine Specialists, S.c.	WI	Emergency Medicine Physician	$0	$35.3M
Wisconsin Diagnostic Laboratories LLC	WI	Clinical Medical Laboratory	$2.3M	$22.7M
Option Care Home Care Inc	WI	Pharmacy	$0	$12.5M
Curative Care Network, Inc.	WI	Rehabilitation Clinic/Center	$0	$12.2M
Children's Specialty Group, Inc.	WI	Pediatrics Physician	$0	$10.4M
Brian Blocher	WI	Oral & Maxillofacial Surgery (D.M.D.)	$0	$5.5M
Nicholas Tosi	WI	Retina Specialist (Ophthalmology) Physician	$4.9M	$0
Wisconsin Laser And Surgery Center LLC	WI	Ambulatory Surgical Clinic/Center	$1.1M	$2.9M

Children's Hospital Of Wisconsin, Inc. — Billing Profile & Reimbursement Data

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Children's Hospital Of Wisconsin, 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