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NPI 1760476659 · Knoxville, TN · Children's Hospital
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East Tennessee Children's Hospital Association, Inc. is a children's hospital provider located in Knoxville, Tennessee. This profile covers 0 Medicare and 219 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 | East Tennessee Children's Hospital Association, Inc. |
| Address | 2018 Clinch Ave |
| City | Knoxville |
| State | TN |
| ZIP | 37916 |
| Taxonomy | Children's Hospital |
| NPI Enumerated | September 7, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $88.6M |
| Medicare | $0 |
This provider is effectively a Medicaid-only operator in our dataset: there is no Medicare billing on file while total Medicaid revenue is $88.6M. Its NPI was enumerated on 2005-09-07 (~21 years ago), indicating it is a long-established pediatric provider rather than a new entrant to the market.
The code mix points to a high-volume pediatric emergency department footprint combined with significant endoscopy capability. High-revenue ED codes (99283, 99284, 99282) and a large volume of 43239 (upper endoscopy with biopsy) signal an operation centered on emergency evaluation and invasive diagnostic procedures consistent with a children’s hospital service mix.
On several specific codes the provider is a statewide outlier: 99282 ranks #1 of 184 providers in-state (100th percentile; extreme outlier, far above typical state volume), 99283 ranks #7 of 611 (99th percentile; extreme outlier, far above typical state volume), and 43239 ranks #3 of 170 (99th percentile; extreme outlier, far above typical state volume). These ranks indicate the provider is a dominant player in Tennessee for multiple pediatric ED and GI endoscopy services.
Beyond ED and GI, the provider shows substantial procedural and surgical capacity for pediatric specialty care: 45380 (colonoscopy biopsy) produced $2.2M (rank #3 of 82, 98th percentile; notably above typical state volume), 69436 (tympanostomy with tube) produced $2M (rank #15 of 65, 78th percentile), and 42820 (tonsil/adenoid removal) produced $1.2M (rank #8 of 51, 86th percentile). These volumes support integrated operative and endoscopic service lines co-located with emergency care.
The provider also reports concentrated pediatric diagnostic and sleep-medicine activity, reinforcing tertiary pediatric capabilities: 95782 (attended sleep study age <6) produced $2M and ranks #1 of 9 providers in-state (100th percentile; typical, unremarkable volume), and 95810 (polysomnography with physician review) produced $1.1M and ranks #2 of 81 (99th percentile; extreme outlier, far above typical state volume). Cardiac imaging volumes (93303, 93306) further indicate in-house pediatric cardiology diagnostics.
There is a meaningful outpatient and laboratory services footprint that complements the high-acuity mix: observation hours (G0378) generated $2M, SARS-CoV-2 testing codes U0003 and 87635 together contributed roughly $2.3M across high claim counts, and outpatient clinic visits (G0463) contributed $923.8K. While the top three codes drive most revenue, these ancillary lines show the provider bills across ED, observation, lab, and clinic settings.
Taken together, the data characterize EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC. as a long-tenured, Medicaid-centric pediatric tertiary/referral center with concentrated revenue in emergency evaluation and endoscopic procedures and dominant statewide standings on multiple pediatric-specific codes. Analysts evaluating network capacity or contracting should view it as a major Medicaid revenue generator and a high-volume center for pediatric ED, GI, surgical, sleep, and cardiac diagnostic services.
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.
219 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 129,860 | $210 | $27.3M |
| 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. | 48,670 | $270 | $13.3M |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 8,800 | $770 | $6.8M |
| 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. | 33,870 | $150 | $5.1M |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 4,850 | $710 | $3.4M |
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 4,870 | $460 | $2.2M |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 1,450 | $1,410 | $2M |
| G0378 | Hospital observation service, per hour | 3,330 | $600 | $2M |
| 95782 | A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters. | 2,600 | $770 | $2M |
| 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… | 36,470 | $50 | $1.6M |
Showing 1–10 of 219
How this provider's Medicaid billing volume and revenue compare to other Tennessee providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Tennessee median
219 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 13 | 60 | 1,340 | $50 | $1.1M |
| 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. | 22 | 630 | 510 | $120 | $1.1M |
| 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. | 7 | 610 | 570 | $110 | $884.4K |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 3 | 30 | 410 | $520 | $719.2K |
| 99285 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making. | 118 | 570 | 640 | $100 | $637.8K |
| 92507 | The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with… | 92 | 230 | 2,130 | $40 | $616.8K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 8 | 50 | 140 | $850 | $541.1K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 8 | 100 | 400 | $60 | $524.7K |
| 93303 | The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization… | 3 | 30 | 1,060 | $130 | $484.1K |
| 95782 | A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters. | 1 | 10 | 1,440 | $370 | $450.5K |
Showing 1–10 of 219
Other providers in the same ZIP code as East Tennessee Children's Hospital Association, Inc., ranked by combined Medicare and Medicaid revenue.
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