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NPI 1760412985 · Watertown, SD · Community/Retail Pharmacy
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Hy-vee Inc is a community/retail pharmacy provider located in Watertown, South Dakota. This profile covers 10 Medicare and 4 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Hy-vee Inc |
| Address | 1320 9th Ave Se |
| City | Watertown |
| State | SD |
| ZIP | 57201 |
| Taxonomy | Community/Retail Pharmacy |
| NPI Enumerated | July 4, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $367.2K |
| Medicaid | $8.9K |
HY-VEE INC (Community/Retail Pharmacy) in WATERTOWN, SD reports substantially more Medicare revenue than Medicaid revenue, with Total Medicare revenue of $367.2K versus Total Medicaid revenue of $8.9K. The dataset flags strong revenue concentration: the top 3 Medicare codes by revenue account for 68.9% of Medicare revenue and the top 3 Medicaid codes by revenue account for 97.3% of Medicaid revenue, indicating a payer mix that is effectively Medicare-dominant with highly concentrated service lines.
The provider’s Medicare billing is dominated by vaccine product codes: 90694 generated $104K (28.3% of Medicare revenue) from 1.4K claims at $76 avg paid/claim, 91322 generated $81.9K (22.3%) from 573 claims at $143 avg paid/claim, and 91320 generated $67.2K (18.3%) from 525 claims at $128 avg paid/claim. This code mix is consistent with a retail pharmacy that focuses on immunizations (seasonal influenza and COVID-19 primary-series/boosters) as a core revenue-driving service line.
Beyond product codes, the provider also bills large volumes for administration and related services — 90480 shows 1.1K claims and $43.9K revenue (12.0% of Medicare revenue), G0008 shows 1.4K claims and $40.9K revenue (11.1%), and K1034 (self-administered COVID test) shows 1.3K claims and $15.5K revenue (4.2%). These claim counts and code mix suggest a high-throughput, point-of-care immunization and testing workflow typical of community pharmacies.
For competitive standing on Medicare vaccine billing, 90694 ranks #40 of 51679 providers nationally (100th percentile) and is described in the source as notably above typical national volume for this code, marking HY-VEE as a high-volume outlier for that influenza vaccine product. By contrast, 91322 and 91320, while among the top revenue-producing codes, are labeled in the source as having typical, unremarkable volume for those vaccine codes in national comparisons despite their high revenue share here.
Medicaid billing is very small in scale but concentrated: E0570 (nebulizer, with compressor) generated $5.6K (62.0% of Medicaid revenue) from 188 claims and ranks #9 of 30 in-state (72th percentile) where the dataset classifies its volume as typical, unremarkable. The remaining Medicaid revenue is driven by vaccine administration and related supplies (90686 $2.1K, 90471 $1.1K, A7015 $250), together producing 97.3% of Medicaid revenue and signaling that Medicaid activity is focused on DME nebulizers plus immunizations.
The absolute scale difference between payers underscores Medicare dominance: Total Medicare revenue is $367.2K while Total Medicaid revenue is $8.9K, so Medicaid appears to be a marginal payer for the provider’s observed operations in this dataset. This pattern reinforces that business, operational, and competitive analysis should focus primarily on Medicare vaccine and administration volumes.
HY-VEE’s NPI tenure (NPI enumerated (registered): 2006-07-04 (~20 years ago)) indicates a long-established billing presence in Medicare and Medicaid, which supports interpreting the high immunization volumes as sustained operational capacity rather than a transient reporting spike. Longevity combined with concentrated vaccine revenues suggests an entrenched retail immunization program at this location.
Operationally, the mix of high-count administration codes (90480, G0008) and product codes (90694, 91322, 91320), plus substantial counts for K1034 (1.3K claims), implies a workflow set up for frequent walk-in immunizations and COVID testing. For payers and competitors, the profile signals that HY-VEE functions primarily as a community vaccination and testing hub with ancillary DME dispensing for Medicaid (E0570), rather than as a broad outpatient clinical services provider.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 90694 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is an inactivated, adjuvanted, preservative–free vaccine given as a 0.5 mL… | 1,370 | $80 | $104K |
| 91322 | This code represents a SARS–CoV–2 vaccine product administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 50 mcg/0.5 mL. | 570 | $140 | $81.9K |
| 91320 | This code represents a SARS–CoV–2 vaccine product (tris–sucrose formulation) administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 30 mcg/0.3 mL. | 530 | $130 | $67.2K |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 1,100 | $40 | $43.9K |
| G0008 | Administration of influenza virus vaccine | 1,410 | $30 | $40.9K |
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 1,290 | $10 | $15.5K |
| 90677 | This code represents a vaccine product administered intramuscularly to protect against pneumococcal disease, a bacterial infection. This is a 20–valent vaccine, protecting against 20 strains of the… | 30 | $270 | $7.8K |
| 0134A | N/A | 100 | $40 | $3.8K |
| 0124A | N/A | 40 | $40 | $1.6K |
| 90686 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL… | 40 | $20 | $860 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| E0570 | Nebulizer, with compressor | 190 | $30 | $5.6K |
| 90686 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL… | 150 | $10 | $2.1K |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 160 | $10 | $1.1K |
| A7015 | Aerosol mask, used with dme nebulizer | 130 | $1 | $250 |
How this provider's Medicaid billing volume and revenue compare to other South Dakota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Dakota median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 89 | 160 | 180 | $40 | $59.6K |
| E0570 | Nebulizer, with compressor | 9 | 30 | 60 | $30 | $9.5K |
| 90686 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL… | 61 | 130 | 110 | $10 | $6.9K |
| A7015 | Aerosol mask, used with dme nebulizer | 3 | 10 | 70 | $1 | $140 |
Other providers in the same ZIP code as Hy-vee Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Human Service Agency | SD | Addiction (Substance Use Disorder) Counselor | $0 | $39M |
| Brown Clinic Pllp | SD | Family Medicine Physician | $0 | $3.1M |
| Thane Evans Crump Dds PC | SD | Endodontics | $0 | $2.3M |
| Human Service Agency | SD | Case Management Agency | $0 | $2.3M |
| Sanford Clinic | SD | Family Medicine Physician | $0 | $2M |
| Prairie Lakes Health Care System Inc | SD | Rural Acute Care Hospital | $0 | $2M |
| Prairie Lakes Home Connections | SD | Supports Brokerage Agency | $0 | $1.2M |
| Big Stone Therapies Watertown, LLC | SD | Physical Therapy Clinic/Center | $0 | $1.1M |
| City Of Watertown | SD | Land Ambulance | $475.4K | $390.4K |
| Bridgeway Counseling Center Inc. | SD | Psychologist | $0 | $813.1K |
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