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

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

Upmc Presbyterian Shadyside (NPI 1821007881)

Field	Value
Entity Type	Organization
Organization	Upmc Presbyterian Shadyside
Address	200 Lothrop St
City	Pittsburgh
State	PA
ZIP	15213
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 7, 2006

Payer Source	Total Paid
Medicaid	$125.5M
Medicare	$0

Key Findings

UPMC PRESBYTERIAN SHADYSIDE is effectively a Medicaid-centered provider: there is no Medicare billing on file while its lifetime Medicaid revenue is $125.5M, indicating the organization’s current public-payer footprint is predominantly Medicaid-driven rather than split across both Medicare and Medicaid. This makes the provider functionally single‑payer in the dataset provided, which has implications for reimbursement risk and contracting focus.

Revenue concentration is high among a small set of behavioral-health codes: the precomputed top-3 Medicaid codes (H2011, T1017, H0039) account for 34.9% of the provider’s total Medicaid revenue. Those three codes individually generate $14.4M (H2011, 12.9%), $14M (T1017, 12.6%), and $10.5M (H0039, 9.4%), so a large share of the $125.5M Medicaid book is tied to crisis intervention, targeted case management, and assertive community treatment.

The code mix strongly indicates a large behavioral-health operation rather than a general acute-care revenue mix: dominant codes include H2011 (crisis intervention), T1017 (targeted case management), H0039 (assertive community treatment), plus high-volume psychotherapy and group therapy codes such as 90834, 90837, 90832, and 90853. High claim counts (for example 51.4K claims for H2011 and 52.3K claims for 90853) and the presence of per‑diem community program codes (S9485, H0037) point to extensive outpatient/community-based mental health services and case management capacity.

Statewide competitive standing is pronounced for several behavioral-health lines: H2011 ranks #1 of 66 providers in-state (100th percentile; extreme outlier) and S9485 ranks #1 of 19 (100th percentile; extreme outlier), while 90853 also ranks #1 of 340 (100th percentile; extreme outlier). Other high placements include 90792 at #2 of 421 (100th percentile; extreme outlier) and G0378 at #2 of 149 (99th percentile; extreme outlier). These ranks indicate the provider is a dominant statewide player for crisis intervention, some per‑diem crisis services, group psychotherapy, and key psychiatric evaluation services.

Emergency department and observation services are material contributors to Medicaid revenue, showing the hospital’s acute care role alongside behavioral health: 99284 accounts for $6.7M (6.0%), G0378 observation services $3.5M (3.2%), 99285 $2.3M (2.1%), and 99283 $1.4M (1.2%). The presence of both ED E/M codes and hospital observation revenue suggests integrated ED throughput and short‑stay observation capacity coexisting with the provider’s behavioral-health programs.

Outpatient psychotherapy and group treatment are substantial throughput drivers: 90834 generated $7.5M (6.7%) with 85.1K claims, 90837 produced $3.9M (3.5%), and 90853 produced $3.7M (3.3%) with 52.3K claims. These volumes and revenues indicate a large ambulatory therapy footprint handling both individual and group psychotherapy at scale within the Medicaid population.

The provider offers a range of intensive and specialized psychiatric services beyond routine outpatient therapy: H0039 (assertive community treatment) brings $10.5M, H0035 (partial hospitalization) $2.9M, and 90870 (ECT) $1.1M — the latter ranking #1 of 2 providers in-state (100th percentile). This mix shows capacity for high‑intensity community and procedural psychiatric services in addition to walk‑in/crisis care.

The NPI has been enumerated since 2006-08-07 (~20 years ago), reflecting an established presence in the market; combined with the high statewide ranks and multiple extreme‑outlier codes, this tenure supports the interpretation that the provider has built a durable, specialized Medicaid behavioral‑health footprint that payers and competitors will likely recognize when assessing network composition and capacity for crisis and community mental-health services.

Medicaid: Complete Services Breakdown

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

579 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2011	Crisis intervention service, per 15 minutes	51,360	$280	$14.4M
T1017	Targeted case management, each 15 minutes	121,900	$120	$14M
H0039	Assertive community treatment, face-to-face, per 15 minutes	77,930	$140	$10.5M
S9485	Crisis intervention mental health services, per diem	12,800	$590	$7.5M
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…	85,100	$90	$7.5M
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.	43,740	$150	$6.7M
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	17,180	$390	$6.6M
H0037	Community psychiatric supportive treatment program, per diem	18,070	$320	$5.7M
H0004	Behavioral health counseling and therapy, per 15 minutes	13,110	$340	$4.4M
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…	24,590	$160	$3.9M

Showing 1–10 of 579

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Upmc Presbyterian Shadyside — 15 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

579 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0039	Assertive community treatment, face-to-face, per 15 minutes	5	40	27,890	$150	$6.2M
H0037	Community psychiatric supportive treatment program, per diem	6	20	8,040	$420	$5.2M
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	58	150	8,280	$220	$4.1M
T1017	Targeted case management, each 15 minutes	7	210	18,200	$100	$2.9M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	28	110	8,460	$150	$2.1M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	39	100	9,680	$110	$1.5M
H2021	Community-based wrap-around services, per 15 minutes	33	220	3,810	$100	$1.5M
G0378	Hospital observation service, per hour	2	150	510	$870	$1.4M
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	58	150	2,770	$200	$1.4M
S9485	Crisis intervention mental health services, per diem	1	20	1,610	$480	$1.3M

Showing 1–10 of 579

Related Providers

Other providers that share a Tax Identification Number (TIN) with Upmc Presbyterian Shadyside, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Upmc Presbyterian Shadyside	PA	Methadone Clinic	$165.7K	$5.9M
Daniel Varon	PA	Geriatric Psychiatry Physician	$44.9K	$0
Tejal Bhojak	PA	Psychiatry Physician	$44K	$0
Marie Anne Gebara	PA	Geriatric Psychiatry Physician	$22.6K	$0
Carmen Andreescu	PA	Psychiatry Physician	$13.7K	$0

Nearby Providers

Other providers in the same ZIP code as Upmc Presbyterian Shadyside, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Upmc Magee-womens Hospital	PA	General Acute Care Hospital	$0	$43M
University Of Pittsburgh Physicians	PA	Psychiatry Physician	$0	$26.4M
University Of Pittsburgh Physicians	PA	Specialist	$0	$23.6M
Shyam Kodati	PA	Ophthalmology Physician	$1.1M	$0
Sandeep Sharma	PA	Nephrology Physician	$900.7K	$0
Badreddine Bencherif	PA	Specialist	$560.6K	$0
Ashima Lall	PA	Diagnostic Radiology Physician	$518.1K	$41.5K
Andrew Eller	PA	Specialist	$509.8K	$290
S. Kreps	PA	Child & Adolescent Psychiatry Physician	$39.8K	$462.6K
Geetha Jeyabalan	PA	Surgery Physician	$370.3K	$0

Upmc Presbyterian Shadyside — Billing Profile & Reimbursement Data

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Upmc Presbyterian Shadyside — 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