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

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

Benefis Hospitals Inc (NPI 1780968974)

Key Findings

Field	Value
Entity Type	Organization
Organization	Benefis Hospitals Inc
Address	1401 25th St S
City	Great Falls
State	MT
ZIP	59405
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	October 6, 2011

Payer Source	Total Paid
Medicaid	$38.2M
Medicare	$0

This provider reports Total Medicare revenue: none (no Medicare billing on file) and Total Medicaid revenue: $38.2M, meaning observed billing activity is effectively single‑payer (Medicaid) in the available claims data. The NPI was enumerated 2011-10-06 (~15 years ago), so the organization has been active for over a decade under this identifier.

Revenue is highly concentrated: the precomputed top three Medicaid codes (99214, 99213, 99284) account for 60.3% of the provider's Medicaid revenue. Specifically, 99214 drives $9M (26.9%), 99213 drives $8.5M (25.4%), and 99284 drives $2.7M (8.0%), signaling that a small group of E/M services account for the majority of Medicaid dollars.

The code mix strongly suggests full hospital-level operations with a heavy emphasis on ambulatory evaluation-and-management services plus emergency and inpatient care. Very large volumes of 99214 and 99213 (98.5K and 116.3K claims respectively) indicate a high-throughput outpatient/clinic footprint, while codes such as 99284, 99285, 99232 and 99223 show parallel ED and inpatient care pathways. Ancillary procedures (74177 CT, 88305 surgical pathology, 93306 echocardiography, 95810 polysomnography, and 01967 neuraxial anesthesia) point to in-house imaging, lab/pathology, cardiology diagnostics, sleep services and obstetric anesthesia capacity.

The provider is a dominant statewide outpatient E/M vendor: 99214 ranks #3 of 532 providers in-state and 99213 ranks #2 of 523 providers in-state, both described as 100th percentile; extreme outlier, far above typical state volume for these codes. Those rankings, together with the $9M and $8.5M revenues on those codes, indicate market leadership in established-patient clinic visits within Montana Medicaid.

Inpatient and ED competitive standing is mixed: inpatient subsequent care 99232 ranks #1 of 32 (100th percentile; extreme outlier) and discharge management 99239 ranks #1 of 21 (100th percentile; notably above typical), indicating unusually high inpatient follow-up and discharge volumes. By contrast, ED-level visits show more typical statewide positioning—99284 is #5 of 75 (95th percentile; typical, unremarkable volume) and 99285 is #11 of 55 (81th percentile; typical, unremarkable volume)—so emergency case mix and acuity-level revenues appear comparable to many peers.

Several ancillary lines show above-typical or unique statewide presence: 93010 (ECG interpretation) is #1 of 44 (100th percentile; extreme outlier) reflecting very high ECG throughput, 95810 polysomnography is #2 of 19 (94th percentile; notably above typical), and 01967 neuraxial anesthesia for planned vaginal delivery is #1 of 1 (0th percentile; no state peer comparison available), suggesting the provider offers specialized peripartum anesthesia services not widely reported among peers. These ancillary services diversify revenue beyond core E/M visits.

The heavy reliance on ambulatory E/M codes (99214 and 99213 make up more than half of Medicaid revenue) creates concentration risk: fluctuations in visit volume, coding policy, or Medicaid reimbursement for E/M services could materially affect overall revenue. Given the Medicaid-only billing footprint in the available data, the provider is also exposed to state Medicaid policy changes and enrollment shifts more than to Medicare market dynamics.

Operational scale is large by encounter counts and dollar volume: examples include 116.3K claims for 99213 and 98.5K claims for 99214, alongside multi‑hundred‑thousand‑dollar contributions from imaging, pathology and specialty services. Combined with the provider’s long-tenure NPI (~15 years), these volumes indicate an established, high-capacity delivery system within the state Medicaid market rather than a small clinic-level operator.

Medicaid: Complete Services Breakdown

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

231 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	98,500	$90	$9M
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…	116,260	$70	$8.5M
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.	23,960	$110	$2.7M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	35,460	$50	$1.8M
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.	10,750	$150	$1.6M
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.	23,800	$70	$1.5M
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…	7,870	$100	$810.5K
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…	5,850	$110	$661.5K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	5,420	$120	$623.3K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	15,220	$40	$593.7K

Showing 1–10 of 231

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Benefis Hospitals Inc — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

231 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0016	Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting)	11	20	3,030	$140	$643.2K
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.	11	60	2,160	$80	$526.7K
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.	5	80	2,770	$60	$471K
00170	The provider performs anesthesia services for a patient undergoing an intraoral procedure, including biopsy.	8	10	30	$290	$289.9K
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	90	2,330	$40	$281.3K
01967	The provider performs neuraxial anesthesia services for a patient undergoing a planned vaginal delivery.	1	10	410	$670	$272.7K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	1	30	770	$60	$233.3K
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…	3	530	580	$70	$224.6K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	5	30	3,780	$40	$222.6K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	169	200	1,110	$60	$207.2K

Showing 1–10 of 231

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Mont	MT	Adult Care Home Facility	$0	$34.7M
Union Associated Physicians Clinic, LLC	IN	Family Medicine Physician	$0	$31.1M
Benefis Hospitals, Inc.	MT	Air Ambulance	$0	$5.2M
Benefis Hospitals, Inc.	MT	General Acute Care Hospital	$0	$3.5M
Syed Akbar	IL	Diagnostic Radiology Physician	$280.8K	$223.7K
Michele Degregorio	MI	Cardiovascular Disease Physician	$436.4K	$0
David Reisman	NH	Hematology & Oncology Physician	$366.8K	$0
James Haug	CO	Diagnostic Radiology Physician	$326.9K	$0
Noman Malik	GA	Diagnostic Radiology Physician	$326.1K	$0
Scott Pargot	MT	Otolaryngology Physician	$57.3K	$263.5K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Great Falls Public Schools	MT	Local Education Agency (LEA)	$0	$15M
Great Falls Pediatric Dentistry, LLC	MT	Pediatric Dentistry	$0	$14.9M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$13.2M
Great Falls Clinic LLC	MT	Multi-Specialty Clinic/Center	$0	$11.2M
Easterseals-goodwill Northern Rocky Mountain, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$7.4M
Levi C Maltby Dmd P.C.	MT	Dentist	$0	$6M
Great Falls Emergency Services Inc	MT	Land Ambulance	$842.6K	$4.4M
Easterseals Goodwill N. Rocky Mtn	MT	Developmentally Disabled Services Day Training Agency	$0	$3.7M
Great Falls Sl, LLC	MT	Assisted Living Facility	$0	$3M
Cmsc, LLC	MT	General Acute Care Hospital	$0	$2.6M

Benefis Hospitals Inc — 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