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

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

T J Samson Community Hospital (NPI 1770581894)

Key Findings

Field	Value
Entity Type	Organization
Organization	T J Samson Community Hospital
Address	1301 N Race St
City	Glasgow
State	KY
ZIP	42141
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 12, 2005

Payer Source	Total Paid
Medicaid	$95.7M
Medicare	$0

T J SAMSON COMMUNITY HOSPITAL is effectively a Medicaid-focused provider with no Medicare billing on file and $95.7M in lifetime Medicaid revenue; this makes the facility functionally single-payer in the dataset and indicates its financial footprint in this analysis is driven entirely by Medicaid activity. The NPI was enumerated on 2005-07-12 (~21 years ago), indicating an established presence in the market.

Revenue concentration is notable: the precomputed top three Medicaid codes account for 38.6% of the hospital’s total Medicaid revenue, signaling a moderate concentration where a relatively small set of services drive a large share of receipts. This suggests business sensitivity to utilization changes or reimbursement policy shifts affecting those top codes.

The largest individual Medicaid revenue driver is G0463 (hospital outpatient clinic visit), with $12.2M (19.6% of total Medicaid revenue) and 187.2K claims; the hospital ranks #4 of 77 in-state (96th percentile), indicating a dominant outpatient clinic role compared with peers and a heavy reliance on clinic-based assessment and management activity. This pattern supports a service-line emphasis on outpatient evaluation and ambulatory care capacity.

Emergency department care is also a major revenue stream: 99284 ($7M, 11.3%) and 99285 ($4.9M, 7.8%) together comprise a substantial share of revenue and reflect high-volume ED throughput with both moderate and high complexity E/M encounters. The rank percentiles (99284 at the 86th and 99285 at the 82nd) place the hospital as a solid mid-to-high volume ED provider within the state but not the top tier.

Several codes present as extreme or notable outliers versus in-state peers, underscoring service strengths: 87502 (multiplex influenza testing) ranks #1 of 191 (100th percentile) and 87635 (SARS–CoV–2 NAAT) ranks #1 of 308 (100th percentile), both far above typical state volumes, while 96372 (injections) also ranks #5 of 865 (100th percentile). These testing and injection volumes point to large throughput in acute care, lab services, and point-of-care treatments, suggesting robust infectious disease testing capacity and routine procedure throughput.

The provider shows above-typical utilization in several diagnostic and therapeutic modalities: 74177 and 74176 CT abdomen/pelvis codes, 70450 CT head, 93306 echocardiography, and 78452 nuclear cardiology are all present in the top revenue list with mid-to-high state rank percentiles (mostly 70th–96th); this mix indicates meaningful imaging and cardiology diagnostic capabilities supporting both ED and outpatient workflows rather than a narrow specialty focus.

Clinic-level E/M and ambulatory outpatient visit codes at lower complexity (99211, 99212, 99213) appear with very high claim counts and high percentiles (for example 99211 ranks #6 of 544 at the 99th percentile), reinforcing a high-volume outpatient practice and frequent use of lower-acuity visits to support overall revenue. This further corroborates the hospital’s operational emphasis on ambulatory and primary-contact services.

Observation and short-stay services are also material: G0379 (direct admission for observation) and G0378 (hospital observation per hour) together contribute revenue and rank in the upper middle of in-state peers, signifying the hospital manages observation-level care frequently and likely uses observation beds as part of its flow between ED and inpatient services.

Medicaid: Complete Services Breakdown

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

525 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	187,210	$70	$12.2M
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.	32,430	$220	$7M
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.	18,770	$260	$4.9M
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.	85,560	$40	$3.5M
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.	24,460	$140	$3.4M
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.	7,870	$350	$2.8M
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	45,790	$50	$2.4M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	24,780	$90	$2.3M
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	8,480	$250	$2.1M
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…	46,150	$50	$2.1M

Showing 1–10 of 525

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

T J Samson Community Hospital — 12 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

525 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.	39	280	7,150	$150	$3M
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.	44	240	4,710	$150	$2.6M
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…	32	70	1,650	$100	$2M
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.	58	280	5,700	$120	$2M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	38	40	740	$1,170	$1.7M
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.	44	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	21	90	2,770	$190	$1.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	4	80	7,740	$30	$1.1M
C1713	Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)	18	40	550	$910	$1.1M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	44	170	2,610	$250	$1M

Showing 1–10 of 525

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
T J Samson Community Hospital	KY	Family Medicine Physician	$0	$15.5M
Mark Risen	KY	Primary Podiatric Medicine Podiatrist	$170K	$444.7K
Matthew Hrastich	MO	Diagnostic Radiology Physician	$134.1K	$399.7K
Kalpesh Patel	AZ	Diagnostic Radiology Physician	$409.1K	$0
Mazen Sabbaq	MI	Pulmonary Disease Physician	$371.9K	$0
Aijaz Yazdani	KY	Pulmonary Disease Physician	$79.8K	$268K
Jennifer Shuemaker	KY	Nephrology Physician	$260.1K	$44.3K
Matthew Rutter	KY	Urology Physician	$287.4K	$0
Barret Lessenberry	KY	Orthopaedic Surgery Physician	$111.9K	$172.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Golden Gate Bridges	KY	Community/Behavioral Health Agency	$0	$17.6M
Oaks Behavioral Health PLLC	KY	Psychiatric/Mental Health Nurse Practitioner	$0	$14.9M
Alliance Counseling Associates	KY	Mental Health Counselor	$0	$12M
Ambulance Service Corporation Inc	KY	Ambulance	$1.2M	$3.4M
Adult Day Health, Inc.	KY	Adult Day Care Clinic/Center	$0	$3.4M
Martha Seeley, LLC	KY	Family Medicine Physician	$0	$2.9M
Mcpeak Surgery Center LLC	KY	Ambulatory Surgical Clinic/Center	$632.4K	$1.6M
Ely Drugs Inc	KY	Community/Retail Pharmacy	$74.8K	$729.2K
Martha Seeley	KY	Family Medicine Physician	$24.7K	$777.3K
Spencer Witcher	KY	Ophthalmology Physician	$487.4K	$50.3K

T J Samson Community Hospital — 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