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

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

Brigham & Womens Hospital, Inc. (NPI 1790717650)

Field	Value
Entity Type	Organization
Organization	Brigham & Womens Hospital, Inc.
Address	75 Francis St
City	Boston
State	MA
ZIP	02115
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 7, 2006

Payer Source	Total Paid
Medicaid	$252.7M
Medicare	$0

Key Findings

This provider bills exclusively to Medicaid on file, with Total Medicaid revenue of $252.7M and no Medicare billing on file; effectively its public-payer footprint in these datasets is single-payer Medicaid. The absence of Medicare claims means any Medicare-facing service-line conclusions cannot be drawn from these records and the provider’s competitive positioning should be evaluated primarily against in-state Medicaid peers.

Revenue is highly concentrated in a small set of outpatient E/M and infusion codes: the precomputed top 3 Medicaid codes account for 46.2% of the provider's total Medicaid revenue. Specifically, 99211 alone generates $47.3M (31.4% of Medicaid revenue), 99213 generates $13.6M (9.1%), and J2350 generates $8.6M (5.7%), indicating a reliance on routine outpatient encounters and high-cost biologic infusions.

The claim volume and unit payments show a hybrid service mix of very high-volume low-acuity visits plus high-cost specialty drug administration. 99211 has 372.2K claims at $127 avg paid/claim and 99213 has 148.3K claims at $92 avg paid/claim, reflecting massive ambulatory/outpatient throughput; at the same time J2350 appears with 1.2K claims at $7033 avg paid/claim, highlighting a parallel specialty infusion business.

Operationally the code mix suggests a large hospital outpatient and infusion program: high counts for G0463 (278.1K claims, $20 avg, $5.6M) and multiple infusion/IV administration codes 96361 (23.2K claims, $8.6M) and 96365 (22.7K claims, $6.9M) point to structured clinic/infusion capacity alongside routine outpatient visits. Emergency services are also material—99283 (49.9K claims, $7M), 99284 (39.4K claims, $5.8M), and 99285 (25.9K claims, $4.7M)—indicating significant ED throughput contributing meaningfully to Medicaid revenue.

Competitive standing in-state is dominant for several high-volume outpatient codes: 99211 ranks #3 of 413 providers in-state and is labeled an "extreme outlier, far above typical state volume for this code," while 99213 ranks #18 of 5303 providers and is also an "extreme outlier." These rankings signal that the provider is a major statewide source of low-acuity outpatient visits reimbursed by Medicaid.

For specialty drugs and biologics the provider is a leading but sometimes niche player: J2350 (ocrelizumab) ranks #1 of 5 providers in-state (100th percentile) and J3380 (vedolizumab) ranks #1 of 7 providers (100th percentile), which shows top-state positioning for certain high-cost infusions even though counts are smaller than routine E/M codes. Other biologics (J1745, J2323) appear with meaningful revenue, signaling a robust specialty infusion program beyond general infusion administration.

Imaging, procedural, and therapy services are also notable contributors beyond E/M and infusion lines: 70553 MRI brain ($3.7M, rank #2 of 112, 99th percentile, extreme outlier), 74177 CT abdomen/pelvis ($2.6M), 97110 therapeutic exercise ($3.4M), and endoscopy codes 43239 and 45380 collectively contribute to a diversified outpatient procedural portfolio. Those high ranks indicate the hospital’s scale in advanced imaging and procedural outpatient work within the state Medicaid market.

The provider has an established operational history with an NPI enumerated on 2006-07-07 (~20 years ago), which, combined with the concentration of outpatient E/M, ED, imaging, and infusion services, suggests long-standing hospital-based ambulatory and infusion infrastructure that drives the observed Medicaid billing patterns. Stakeholders should view this profile as a mature, high-volume Medicaid outpatient and infusion center with concentrated revenue streams in a handful of dominant codes.

Medicaid: Complete Services Breakdown

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

943 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	372,170	$130	$47.3M
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…	148,330	$90	$13.6M
J2350	Injection, ocrelizumab, 1 mg	1,220	$7,030	$8.6M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	23,170	$370	$8.6M
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.	49,920	$140	$7M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	22,690	$300	$6.9M
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.	39,410	$150	$5.8M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	278,060	$20	$5.6M
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.	25,930	$180	$4.7M
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…	73,140	$60	$4.1M

Showing 1–10 of 943

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Brigham & Womens Hospital, Inc. — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

943 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	14	90	7,560	$350	$4.2M
J2350	Injection, ocrelizumab, 1 mg	1	10	130	$7,900	$3.9M
S9485	Crisis intervention mental health services, per diem	44	110	1,250	$540	$3.2M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	3	10	1,380	$1,380	$2.7M
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	18	20	310	$260	$2.1M
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	4	10	1,200	$1,560	$2.1M
J2357	Injection, omalizumab, 5 mg	4	10	1,540	$850	$1.6M
J3380	Injection, vedolizumab, intravenous, 1 mg	1	10	330	$2,790	$1.6M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	12	50	1,870	$210	$1.4M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	6	10	1,070	$220	$1.4M

Showing 1–10 of 943

Related Providers

Other providers that share a Tax Identification Number (TIN) with Brigham & Womens Hospital, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brigham & Womens Physicians Organization Inc	MA	Internal Medicine Physician	$0	$43.6M
Brigham & Women's Physicians Organization Inc	MA	Radiation Oncology Clinic/Center	$2.7M	$760
Roman Klufas	MA	Neuroradiology Physician	$475.7K	$441.9K
Andrew Matson	RI	Orthopaedic Hand Surgery Physician	$39.5K	$746.1K
Emad Attallah-wasif	OK	Pain Medicine (Anesthesiology) Physician	$742K	$0
Shalini Moningi	OH	Radiation Oncology Physician	$723.2K	$0
Paul Massey	MA	MOHS-Micrographic Surgery Physician	$621.3K	$0
Kenneth Yu	MA	MOHS-Micrographic Surgery Physician	$589.6K	$0
Seth Mcclennen	MA	Clinical Cardiac Electrophysiology Physician	$548.9K	$0
Dennis Kim	NY	MOHS-Micrographic Surgery Physician	$521K	$0

Nearby Providers

Other providers in the same ZIP code as Brigham & Womens Hospital, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital Corporation	MA	Children's Hospital	$0	$330.9M
Children's Hospital Pediatric Associates, Inc	MA	Pediatrics Physician	$0	$19.1M
John Chi	MA	Neurological Surgery Physician	$444.6K	$0
An Bui	MA	Internal Medicine Physician	$410.9K	$0
Mohammadali Mojarrad	MA	Diagnostic Radiology Physician	$343.4K	$40.3K
James Kang	MA	Orthopaedic Surgery Physician	$371.1K	$0
Monica Krishnan	MA	Radiation Oncology Physician	$340.4K	$0
Kee Chung	MA	Pediatric Radiology Physician	$207.1K	$107.4K
Joseph Kavolus	MA	Orthopaedic Surgery Physician	$306.9K	$0
Michael Kearney	MA	Urology Physician	$302.9K	$0

Brigham & Womens Hospital, Inc. — Billing Profile & Reimbursement Data

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Brigham & Womens Hospital, 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