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

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

Sac Health System (NPI 1801270137)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sac Health System
Address	250 South G Street
City	San Bernardino
State	CA
ZIP	92410
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	July 16, 2015

Payer Source	Total Paid
Medicaid	$260M
Medicare	$0

SAC HEALTH SYSTEM is effectively a single-payer Medicaid provider: there is no Medicare billing on file while total Medicaid revenue is $260M, indicating its entire recorded public-reimbursement footprint in the dataset is driven by Medicaid rather than Medicare. This concentration implies operational focus on Medicaid-eligible patient populations and services reimbursed under California Medicaid programs.

Revenue concentration is highly skewed toward a single code: T1015 accounts for $227.5M or 87.6% of the provider’s total Medicaid revenue, and the precomputed top three codes collectively account for 96.7% of Medicaid revenue. This level of concentration indicates that the clinic’s financial model depends overwhelmingly on the clinic visit/encounter all-inclusive payment structure represented by T1015.

The code mix and top reimbursed services indicate an FQHC-style, high-volume primary care and behavioral health operation: T1015 (clinic visit/encounter, all-inclusive) dominates revenue while large claim volumes for evaluation/management codes (99213, 99214, 99215) and psychotherapy codes (90834, 90837, 90832) show a mix of primary care and integrated behavioral health encounters. Preventive and pediatric visit codes (99391, 99381) and vaccine codes (90686, 90677, 90715) further support a broad primary care and public-health preventive services profile typical for a Federally Qualified Health Center.

SAC HEALTH SYSTEM is a statewide outlier on multiple Medicaid codes, reflecting dominant scale in California for several service lines. T1015 ranks #2 of 1550 providers in-state (100th percentile; extreme outlier), 99213 and 99214 rank in the 100th percentile for their respective denominators, and several psychotherapy and care-management codes (90834, 90837, G9012, G9008) are at or above the 97th–99th percentiles. These rankings collectively characterize the provider as a major volume leader for clinic-based visits and related care coordination services in California.

Operational implications: given that T1015 is the single largest revenue driver and that G0467 (FQHC visit) appears with modest revenue ($236.9K) and a mid-range in-state rank (59th percentile), the provider appears to bill heavily under a non-FQHC bundled clinic visit code in Medicaid while also operating FQHC-structured services for some encounters. This suggests a hybrid billing pattern where a large majority of encounters are captured under the all-inclusive clinic visit code, with supplemental activity across standard E/M and behavioral health codes.

Tenure and established presence: the NPI was enumerated on 2015-07-16 (~11 years ago), indicating over a decade of participation in public programs. Combined with the extreme volume metrics and rank outliers across many codes, this tenure supports the interpretation that the provider has an established, sustained operational footprint in the region.

Service mix risk and operational sensitivity: because 87.6% of Medicaid revenue comes from one code (T1015) and the top three codes produce 96.7% of Medicaid revenue, revenue is highly sensitive to changes in reimbursement policy, coding guidance, or utilization patterns tied to that bundled clinic visit code. Any payer policy shifts that affect payment rates or eligibility for T1015 could materially impact the organization’s financials.

Behavioral health scale: psychotherapy and psychiatric evaluation codes (90834, 90837, 90832, 90791, 90792) appear among the top-revenue codes and frequently rank in high percentiles statewide, which indicates a substantial behavioral health service line within the clinic footprint. The presence of high-volume care management codes (G9012, G9008) also suggests investment in coordinated care processes and case-management capacity that support complex or high-need Medicaid populations.

Medicaid: Complete Services Breakdown

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

170 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	717,560	$320	$227.5M
00003	N/A	54,280	$400	$21.5M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	41,030	$50	$1.9M
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…	449,330	$1	$1.8M
59425	This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior…	21,240	$60	$1.3M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	14,690	$80	$1.2M
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…	238,680	$1	$954.7K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	17,430	$40	$627.5K
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…	7,730	$50	$347.7K
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…	17,140	$20	$308.5K

Showing 1–10 of 170

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. California Distribution

Sac Health System — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — California

Full comparison — all codes billed, vs. California median

170 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	2	1,550	38,050	$190	$14.1M
00003	N/A	97	690	14,940	$260	$7.7M
H0034	Medication training and support, per 15 minutes	235	280	990	$250	$2.6M
G9012	Other specified case management service not elsewhere classified	11	720	1,110	$110	$651.3K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	127	4,290	780	$140	$400.1K
G9008	Coordinated care fee, physician coordinated care oversight services	5	490	660	$70	$396.7K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	99	390	250	$200	$220.4K
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which…	419	1,030	1,050	$70	$219.7K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	11	1,950	500	$80	$179K
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…	10	13,300	640	$40	$169.6K

Showing 1–10 of 170

Sac Health System — Billing Profile & Reimbursement Data

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Sac Health System — 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

Frequently Asked Questions

References