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

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

Texas Children's Physician Group (NPI 1861675506)

Key Findings

Field	Value
Entity Type	Organization
Organization	Texas Children's Physician Group
Address	6621 Fannin St
City	Houston
State	TX
ZIP	77030
Taxonomy	Pediatrics Physician
NPI Enumerated	December 17, 2007

Payer Source	Total Paid
Medicaid	$160.6M
Medicare	$0

This provider has no Medicare billing on file and reports $160.6M in lifetime Medicaid revenue, making its public billing footprint effectively single‑payer (Medicaid) at the scale reported. The absence of Medicare revenue indicates analysts should treat observed patterns as Medicaid-driven for network, utilization, and competitive impact assessments rather than mixed-payer dynamics.

Revenue is concentrated in a small set of E/M codes: the precomputed top three Medicaid codes (99284, 99214, 99244) together account for 36.1% of the provider’s total Medicaid revenue. Individually these codes generate $19.8M (99284, 15.7%), $15.7M (99214, 12.4%), and $10.1M (99244, 8.0%), so a little over one‑third of Medicaid revenue is tied to a focused group of emergency, outpatient, and consultation E/M services.

The code mix signals a large, integrated pediatric clinical operation with heavy emergency and outpatient evaluation-and-management activity: 99284 (181.8K claims, $19.8M) is the single largest revenue driver and is accompanied by high-volume E/M codes 99214 (261.9K claims, $15.7M), 99213 (207.4K claims, $8.7M), and 99215 (106.1K claims, $9.4M). The prominence of ED-level codes (99284, 99283, 99285) alongside high-volume office E/M codes suggests combined emergency department, ambulatory clinic, and consult services rather than a narrowly outpatient-only practice.

Neonatal and critical care services represent an important service line: 99472 (follow-up care of a critically ill infant) generated $6M (4.7%) and ranks #1 of 26 providers in-state (100th percentile; notably above typical state volume), while 99469, 99480, and 99460 also appear in the top 25 with nontrivial revenue. These codes, together with high ranks on critical care code 99291 (18K claims, $4.2M, ranks #3 of 280; 99th percentile; extreme outlier), indicate substantial inpatient/NICU and critical-care throughput.

Surgical and procedural pediatric services are present and material: anesthesia for intraoral procedures (00170) produced $5.3M (4.2%) and tympanostomy with tube insertion (69436) produced $2.1M (1.6%) and ranks #1 of 125 providers in-state (100th percentile; extreme outlier). High-ranked anesthesia and surgical procedure volumes imply the provider supports operating room or procedure-suite activity in addition to ED and clinic care.

Specialty diagnostics and tertiary services are also concentrated here: echocardiography codes 93303 and 93306 each contribute roughly $1.7M and rank at or near the top in-state, and EEG interpretation 95720 generated $1.6M while ranking #1 of 21 providers in-state (100th percentile). This pattern is consistent with embedded pediatric cardiology and neurology services that support complex inpatient and outpatient case mix.

Competitive standing in Texas is dominant for many pediatric service lines: multiple codes are labeled as “extreme outlier” or at the 100th percentile in-state (for example, 99244 is #1 of 206, 99214 is #4 of 5814, 99233 is #3 of 956), reflecting volumes far above typical state providers on these services. For payer strategy and network-design work, treat this entity as a major statewide pediatric volume center across ED, consult, inpatient, NICU, and specialty procedural/service lines.

The provider has been enumerated since 2007-12-17 (~19 years ago), indicating an established presence in the market; this tenure, combined with very large claim counts on many top codes (e.g., 261.9K claims for 99214 and 181.8K claims for 99284), reinforces that observed dominance is sustained rather than transient. Analysts should factor both longevity and concentrated Medicaid exposure into risk, contracting, and access models for pediatric services in the region.

Medicaid: Complete Services Breakdown

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

343 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	181,840	$110	$19.8M
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…	261,870	$60	$15.7M
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	62,610	$160	$10.1M
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…	106,070	$90	$9.4M
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…	207,360	$40	$8.7M
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	52,430	$120	$6M
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.	14,140	$420	$6M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	71,680	$80	$5.7M
00170	The provider performs anesthesia services for a patient undergoing an intraoral procedure, including biopsy.	20,000	$260	$5.3M
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.	68,460	$60	$4.2M

Showing 1–10 of 343

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Texas Distribution

Texas Children's Physician Group — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. Texas median

343 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	12	30	1,410	$340	$2.5M
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.	5	710	1,790	$200	$2.1M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	17	30	3,360	$120	$1.2M
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.	1	30	1,140	$370	$1.2M
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.	22	730	1,960	$100	$1M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	8	40	1,860	$110	$997.5K
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.	29	590	740	$170	$969.2K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	3	30	330	$1,020	$750.2K
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…	3	70	850	$180	$621.2K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	1	60	340	$590	$491.5K

Showing 1–10 of 343

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alicia Genisca	RI	Pediatric Emergency Medicine (Pediatrics) Physician	$0	$790.5K
Joshua Duncan	AZ	Ophthalmology Physician	$540.5K	$0
Richard Allen	TX	Ophthalmic Plastic and Reconstructive Surgery Physician	$170.2K	$0
Christopher Smith	TX	Urology Physician	$157.8K	$0
Chirag Patel	SD	Internal Medicine Physician	$141.6K	$0
Tonye Masse	TX	Physician Assistant	$140.3K	$0
John Muenchrath	OR	Urology Physician	$110.7K	$0
Siva Marri	OR	Pulmonary Disease Physician	$88.1K	$0
Jarmara Darcey	TX	Obstetrics & Gynecology Physician	$78.6K	$0
William Morrison	TX	Therapeutic Radiology Physician	$70.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Texas Children's Hospital	TX	Children's Hospital	$0	$277.4M
Ut Physicians	TX	Anesthesiology Physician	$0	$94.4M
Texas Children's Urgent Care	TX	Pediatrics Physician	$0	$63.7M
Memorial Hermann Health System	TX	General Acute Care Hospital	$0	$39.5M
Harris County Hospital District	TX	General Acute Care Hospital	$0	$27.7M
Baylor College Of Medicine	TX	Family Medicine Physician	$0	$18.1M
Igor Cherches	TX	Neurology Physician	$6.7M	$0
David Brown	TX	Ophthalmology Physician	$5.7M	$0
Tien Wong	TX	Ophthalmology Physician	$4.5M	$0
Ankoor Shah	TX	Ophthalmology Physician	$3.7M	$0

Texas Children's Physician Group — 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