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

Why is the Medicaid comparison limited to 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. 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.

Upper Mattaponi Indian Tribe (NPI 1750969168)

Key Findings

Field	Value
Entity Type	Organization
Organization	Upper Mattaponi Indian Tribe
Address	7864 Richmond Tappahannock Hwy
City	Aylett
State	VA
ZIP	23009
Taxonomy	Primary Care Clinic/Center
NPI Enumerated	March 30, 2021

Payer Source	Total Paid
Medicaid	$75.6M
Medicare	$0

UPPER MATTAPONI INDIAN TRIBE reports no Medicare billing on file and $75.6M in lifetime Medicaid revenue, making it effectively a Medicaid-focused provider in this dataset. The precomputed top-3 Medicaid codes by revenue account for 97.2% of its total Medicaid revenue, indicating concentrated dependence on a small set of Medicaid service lines.

The provider's revenue mix is overwhelmingly driven by home- and community-based services: S5121 (Chore services; per diem) accounts for $48.2M (63.8% of Medicaid revenue) with 33.9K claims, and Q5009 (Hospice or home health care provided in place NOS) contributes $24.4M (32.3% of Medicaid revenue) with 30.1K claims. This code mix suggests the organization operates large-scale in-place home health, hospice, and personal assistance type services rather than a revenue model centered on office-based primary care.

Revenue concentration creates operational and contracting exposure: the top 3 Medicaid codes by revenue account for 97.2% of the provider’s Medicaid revenue, so changes in reimbursement, program enrollment, or authorization patterns for S5121 or Q5009 would materially affect the provider’s financials. Payers should note that a small number of service lines drive nearly all reported Medicaid payments.

S5121 (33.9K claims, $48.2M revenue) ranks #2 of 3 providers in-state and is labeled a 50th percentile provider with a typical, unremarkable volume for this code. Despite the large absolute revenue dollar value, its in-state rank and descriptor indicate the provider is not an extreme outlier for chore services within Virginia’s small peer set.

Q5009 (30.1K claims, $24.4M revenue) ranks #1 of 2 providers in-state at the 100th percentile and is described as having a typical, unremarkable volume for this code. Within the very small peer group that reports this hospice/home-health NOS code, UPPER MATTAPONI appears to be the leading reporter, which may reflect a localized specialization in in-place hospice/home health services.

Office-based evaluation and management and standard lab work represent a small share of Medicaid revenue: 99213 contributes $898.4K (1.2% of Medicaid revenue) and ranks #1136 of 4012 providers in-state (72th percentile; typical, unremarkable volume). This indicates routine primary care visits and common labs are present but are not a significant revenue driver relative to the home- and community-based services.

The provider’s NPI was enumerated on 2021-03-30 (~5 years ago), indicating relatively recent enrollment. Accumulating $75.6M in Medicaid revenue over the ~5-year period suggests a rapid ramp or concentrated billing strategy in the provider’s core HCBS/hospice service lines rather than a long-standing, diversified outpatient practice.

For payer strategy and network planning, the absence of Medicare billing means the provider will not appear in Medicare-based performance or utilization analyses; Medicaid payers and care managers should therefore treat this entity as effectively single-payer (Medicaid) for the purposes of utilization review and contracting. Given the high revenue concentration in S5121 and Q5009, Medicaid plans should prioritize audit, utilization management, and authorization workflows around these specific codes when assessing financial risk and care quality for this provider.

Medicaid: Complete Services Breakdown

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5121	Chore services; per diem	33,870	$1,420	$48.2M
Q5009	Hospice or home health care provided in place not otherwise specified (nos)	30,060	$810	$24.4M
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…	1,350	$670	$898.4K
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.	660	$680	$447.4K
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…	650	$680	$441.9K
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…	610	$690	$420.4K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	440	$680	$297.2K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	250	$680	$171.3K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	140	$720	$103.5K
84443	The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the…	110	$650	$68.3K

Showing 1–10 of 19

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Upper Mattaponi Indian Tribe — 1 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

19 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5121	Chore services; per diem	2	10	33,870	$1,330	$66.9M
Q5009	Hospice or home health care provided in place not otherwise specified (nos)	1	10	22,960	$800	$18.4M
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…	1,529	3,520	370	$70	$280.7K
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…	1,136	4,010	290	$50	$199.8K
T1015	Clinic visit/encounter, all-inclusive	13	20	170	$90	$193.9K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	309	610	150	$90	$104K
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.	152	230	5,240	$1	$93.2K
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…	958	1,000	100	$70	$81.1K
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…	175	230	300	$40	$65.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	393	430	160	$80	$60.2K

Showing 1–10 of 19

Upper Mattaponi Indian Tribe — Billing Profile & Reimbursement Data

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Upper Mattaponi Indian Tribe — 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

Nearby Providers

Frequently Asked Questions

References