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

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

Mcallen Hospitals L P (NPI 1770573586)

Key Findings

Field	Value
Entity Type	Organization
Organization	Mcallen Hospitals L P
Address	1102 W Trenton Rd
City	Edinburg
State	TX
ZIP	78539
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 24, 2005

Payer Source	Total Paid
Medicaid	$124.6M
Medicare	$0

This provider is effectively single‑payer in the available data: there is no Medicare billing on file and total Medicaid revenue is $124.6M, indicating the facility’s Medicaid business represents its entire reported federal payer footprint. Analysts should treat MCALLEN HOSPITALS L P as a Medicaid‑centered operation when modeling payer mix or negotiating state arrangements.

Revenue is extremely concentrated in emergency department evaluation and management codes: the top three Medicaid codes (99284, 99285, 99283) together account for 82.4% of the provider’s Medicaid revenue, with 99284 generating $62.9M (52.8%), 99285 generating $26.3M (22.0%), and 99283 generating $9.1M (7.6%). This concentration signals that the ED is the primary revenue engine and that any changes to ED reimbursement or utilization would materially affect overall revenue.

The code mix and high-volume patterns point to a high-throughput, acuity‑weighted ED operation supported by observation and acute-care services: G0378 (hospital observation service, per hour) appears with $3.2M (3.9K claims) and ranks #4 of 73 in-state (96th percentile), while IV hydration/additional-hour code 96361 contributes $1.1M (2.5K claims). Together these support a care-delivery model where many ED patients are held for observation or receive time-based treatments rather than immediate inpatient admission.

MCALLEN HOSPITALS L P is a dominant statewide ED provider on several measures: 99284 ranks #10 of 714 providers in-state (99th percentile; extreme outlier), 99283 ranks #9 of 732 (99th percentile; extreme outlier), and 99285 ranks #17 of 587 (97th percentile; notably above typical state volume). These rank/percentile signals indicate the hospital is far above typical state volume for moderate- and high‑complexity ED visits and should be viewed as a major competitor for emergency services in the region.

Laboratory and diagnostic testing volumes are unusually large and concentrated on infectious disease and ED-focused diagnostics, which aligns with the ED-centric revenue picture: C9803 (COVID specimen collection) shows 61.4K claims, $1.4M revenue and ranks #1 of 142 in-state (100th percentile; extreme outlier), 87426 (SARS–CoV-2 assay) has 44.1K claims and $2.1M revenue (99th percentile; notably above typical), and 87804 (influenza test) has 84.3K claims and $1.9M revenue (100th percentile; extreme outlier). These volumes suggest significant ancillary revenue tied to testing throughput and ED patient flow.

Several ancillary procedure and imaging codes are present at high state percentiles, supporting acute diagnostic capability: 93005 (ECG recording) shows 17.9K claims and $1.3M revenue (98th percentile), 74177 (CT abdomen/pelvis with contrast) contributes $1.4M (3.8K claims, 89th percentile), and 70450 (CT head without contrast) contributes $614.3K (5.2K claims, 90th percentile). The combination of high ECG, CT, and laboratory volumes reinforces the characterization of a busy ED with substantial diagnostic throughput.

The provider reports very high state relative volume on some commonly used ancillary and medication codes, indicating standardized ED care pathways: J1885 (ketorolac injection) is $342.3K and ranks #2 of 339 providers in-state (100th percentile; extreme outlier), and common lab panel codes (80053, 85025) are each in the 99th percentile for in-state volume. These patterns are consistent with protocolized ED management where certain medications, labs, and point-of-care tests are used at scale.

MCALLEN HOSPITALS L P is an established entity with an NPI enumeration date of 2005-10-24 (~21 years ago), which supports interpreting these utilization patterns as mature operational behavior rather than transient or startup anomalies. Given the sustained, high-volume ED and testing footprint, payers and network planners should consider the hospital a long-standing, Medicaid-centric acute care hub in the region when assessing capacity, network adequacy, or reimbursement policy impacts.

Medicaid: Complete Services Breakdown

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

212 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	105,160	$600	$62.9M
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.	39,980	$660	$26.3M
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.	113,770	$80	$9.1M
G0378	Hospital observation service, per hour	3,950	$820	$3.2M
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	44,140	$50	$2.1M
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	84,310	$20	$1.9M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	3,790	$360	$1.4M
C9803	Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	61,380	$20	$1.4M
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	17,910	$70	$1.3M
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	20,870	$60	$1.1M

Showing 1–10 of 212

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Texas Distribution

Mcallen Hospitals L P — 15 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. Texas median

212 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	10	710	1,790	$200	$2.1M
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.	9	730	1,960	$100	$1M
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.	17	590	740	$170	$969.2K
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…	151	340	400	$50	$553.5K
G0378	Hospital observation service, per hour	4	70	300	$500	$465K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	86	110	80	$1,260	$398.1K
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	56	160	200	$280	$321.8K
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	18	150	170	$30	$302.9K
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	109	240	420	$30	$296.8K
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.	17	370	360	$120	$279.5K

Showing 1–10 of 212

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Doctors Hospital At Renaissance, Ltd	TX	General Acute Care Hospital	$0	$65.1M
Tropical Texas Behavioral Health	TX	Multi-Specialty Clinic/Center	$0	$61.5M
Nuestro Sagrado Corazon Primary Home Care, Inc.	TX	Personal Care Attendant	$0	$56.5M
Regional Nursing Services Mgmt., Inc.	TX	Home Health Agency	$0	$45.5M
Verge Primary Home Care	TX	Personal Care Attendant	$0	$42.7M
Arc Primary Care, LLC.	TX	Home Health Agency	$0	$42.3M
Heaven Sent Services, L.L.C.	TX	Personal Care Attendant	$0	$40.4M
Ddnj, Inc.	TX	In Home Supportive Care Agency	$0	$34.3M
Life Choices Unlimited, Inc.	TX	Child Intellectual and/or Developmental Disabilities Respite Care	$0	$28M
Palm Valley Primary Home Care, Inc.	TX	Personal Care Attendant	$0	$27.6M

Mcallen Hospitals L P — 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