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

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

The Children's Mercy Hospital (NPI 1851437719)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Children's Mercy Hospital
Address	2401 Gillham Rd
City	Kansas City
State	MO
ZIP	64108
Taxonomy	Pediatrics Physician
NPI Enumerated	January 29, 2007

Payer Source	Total Paid
Medicaid	$53.6M
Medicare	$0

This provider is effectively single‑payer on file: there is no Medicare billing on file while lifetime Medicaid revenue totals $53.6M, indicating the organization's claims activity in our dataset is dominated by Medicaid. Analysts should treat Medicaid as the primary revenue source when modeling payer exposure or contracting strategy for this entity.

Revenue is highly concentrated in a small set of outpatient E/M and ED codes: the precomputed top‑3 Medicaid codes (99213, 99214, 99283) account for 51.6% of the provider's total Medicaid revenue. Those three codes alone are 99213 ($11.4M, 24.4%), 99214 ($6.5M, 14.0%), and 99283 ($6.2M, 13.2%), which signals dependence on routine office visits and emergency department visits for the majority of billed Medicaid dollars.

The code mix points to a large pediatric ambulatory and emergency operation with integrated inpatient neonatal care: high volumes of 99213 and 99214 reflect extensive established outpatient visits, 99283/99284/99285 represent substantial ED throughput across acuity levels, and 99472 (13K claims, $4.2M, 8.9%) indicates concentrated follow‑up care for critically ill infants. Together these patterns are consistent with a pediatric hospital system that provides primary ambulatory care, emergency services, and specialized inpatient neonatal services.

The provider is a statewide dominant performer on many high‑volume pediatric codes: 99213 ranks #1 of 4312 providers in‑state (100th percentile; extreme outlier), 99283 ranks #1 of 1263 providers (100th percentile; extreme outlier), and multiple echocardiography and preventive codes also rank at or near the top of state lists. These rank/percentile signals indicate the provider is a major market player in Missouri for both routine pediatric visits and specialized pediatric services.

Cardiac imaging and diagnostic services are a notable revenue stream beyond E/M: 93303 ($919.2K), 93320 ($572.7K), 93325 ($465.2K), and 93306 ($493.6K) each appear with sizable volumes and several rank as #1 in‑state, indicating an organizational capability or service line in pediatric echocardiography that complements ambulatory and inpatient care. Analysts evaluating service capacity or referral flows should account for this concentrated diagnostic footprint.

Preventive medicine and developmental screening are material and high‑ranked components of the outpatient mix: well‑child/preventive codes 99392 ($600.1K), 99391 ($457K), and 99393 ($410.4K) are all high‑volume and in several cases rank #1 in‑state, while 96110 ($356.3K) for developmental screening also ranks #1. This pattern signals a broad preventive and developmental practice footprint, important for forecasting vaccination, screening, and longitudinal pediatric care demand.

The emergency department presents a full spectrum of acuity: 99284 (43K claims, $3.5M, 7.5%) ranks #5 of 953 providers (100th percentile; extreme outlier) and 99285 (8.3K claims, $936.7K, 2.0%) ranks #47 of 596 (92th percentile; typical, unremarkable volume), showing very high volume at moderate acuity together with a non‑trivial number of high‑acuity visits. This mix suggests the ED is a core access point for the population served and drives significant outpatient and observation care downstream.

The NPI tenure indicates an established operation: enumerated 2007-01-29 (~19 years ago), the provider shows mature, sustained Medicaid engagement with very large claim counts on key codes (for example 211.1K claims for 99213). For payer contracting, network planning, or utilization management, treat this entity as a long‑standing, high‑volume pediatric system with entrenched service lines in outpatient E/M, emergency care, neonatal follow‑up, and pediatric diagnostics.

Medicaid: Complete Services Breakdown

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

269 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	211,060	$50	$11.4M
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…	89,580	$70	$6.5M
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.	139,800	$40	$6.2M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	13,050	$320	$4.2M
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…	35,280	$110	$3.7M
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.	43,020	$80	$3.5M
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…	26,010	$80	$2M
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.	8,290	$110	$936.7K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	15,850	$60	$919.2K
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…	16,430	$50	$739.2K

Showing 1–10 of 269

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

The Children's Mercy Hospital — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

269 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	47	600	140	$170	$384.1K
S9083	Global fee urgent care centers	4	20	1,510	$100	$366.9K
67311	The provider realigns an imbalance in the eye muscles by either recession, which weakens the eye muscle or resection, which strengthens the muscles so as to restore normal vision. This procedure is…	5	10	30	$1,170	$301.3K
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	950	120	$150	$288.2K
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.	1	1,260	220	$120	$242.4K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	5	30	110	$1,230	$229.7K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	1	40	100	$330	$144.9K
80076	The lab analyst performs a hepatic function panel test in which he measures the blood levels of total protein, albumin, alkaline phosphatase, bilirubin, both total and direct, and liver enzymes.	24	40	70	$70	$144.3K
87430	The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.	37	40	200	$160	$143.1K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	33	90	120	$250	$141.3K

Showing 1–10 of 269

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Children's Mercy Hospital	MO	Children's Hospital	$0	$221M
The Children's Mercy Hospital	MO	Durable Medical Equipment & Medical Supplies	$0	$28.3M
The Children's Mercy Hospital	KS	Children's Hospital	$0	$22.3M
The Children's Mercy Hospital	MO	Ambulance	$0	$13.4M
Children's Mercy-community Choice Pediatrics	MO	Pediatrics Physician	$0	$9M
David Dyer	KS	Ophthalmology Physician	$7.5M	$0
Children's Mercy-cockerell And Mcintosh Pediatrics, Inc	MO	Pediatrics Physician	$0	$6.3M
University Of Kansas Hospital Authority	KS	Multi-Specialty Clinic/Center	$0	$3.9M
Abraham Poulose	KS	Retina Specialist (Ophthalmology) Physician	$1.8M	$0
Atul Patel	KS	Physical Medicine & Rehabilitation Physician	$932.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Truman Medical Center, Incorporated	MO	General Acute Care Hospital	$0	$233.8M
University Health Physicians	MO	Internal Medicine Physician	$0	$102.8M
Truman Medical Center, Incorporated	MO	Community/Behavioral Health Agency	$0	$37.8M
Bethel Home Healthcare LLC	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$24.3M
Truman Medical Center, Incorporated	MO	Otolaryngology Physician	$0	$14.1M
Help At Home, LLC	MO	Nursing Care Agency	$0	$5.2M
Truman Medical Center Incorporated	MO	Body Imaging Physician	$0	$4.6M
Truman Medical Center Incorporated	MO	Community/Behavioral Health Agency	$0	$4.6M
Aspire Home Health Inc	MO	Home Health Agency	$0	$4.5M
Jordan Smith	MO	Diagnostic Radiology Physician	$316.6K	$0

The Children's Mercy 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