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

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

Wayne County Hospital, Inc (NPI 1871548016)

Wayne County Hospital, Inc is a critical access hospital provider located in Monticello, Kentucky. This profile covers 0 Medicare and 143 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Wayne County Hospital, Inc
Address	166 Hospital St
City	Monticello
State	KY
ZIP	42633
Taxonomy	Critical Access Hospital
NPI Enumerated	May 24, 2006

Payer Source	Total Paid
Medicaid	$17.7M
Medicare	$0

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

143 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.	25,020	$160	$4.1M
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.	28,350	$110	$3.1M
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.	6,280	$290	$1.8M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	3,650	$330	$1.2M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	11,430	$80	$937.3K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	6,390	$90	$549.4K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	21,890	$30	$547.1K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	2,130	$240	$517.1K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	5,330	$80	$442K
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.	2,760	$150	$408.8K

Showing 1–10 of 143

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Wayne County Hospital, Inc — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

143 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	236	310	830	$120	$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.	54	280	7,150	$150	$3M
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.	106	240	4,710	$150	$2.6M
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.	45	280	5,700	$120	$2M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	143	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	70	90	2,770	$190	$1.3M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	57	170	2,610	$250	$1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	44	110	8,390	$50	$749.1K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	108	180	2,960	$110	$672.4K
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.	73	100	5,870	$70	$670.3K

Showing 1–10 of 143

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
David Mayer	KY	Surgery Physician	$50.5K	$51.8K
Billy Trent	TN	Diagnostic Radiology Physician	$44.7K	$0
Mark Nowell	TN	Surgery Physician	$17.3K	$0
Christopher Stumbo	KY	Family Medicine Physician	$8.3K	$800

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Angela Tucker	KY	Mental Health Counselor	$0	$4.6M
Rise Mental Health And Wellness	KY	Mental Health Counselor	$0	$3.3M
Eric Johnson	KY	Diagnostic Radiology Physician	$78.6K	$3.1M
Lake Cumberland Pediatrics PLLC	KY	Rural Health Clinic/Center	$0	$3.1M
Horizon Adult Health Care LLC	KY	Occupational Therapist	$0	$3.1M
Faith Healthcare Inc	KY	Federally Qualified Health Center (FQHC)	$0	$3M
Phillips Pratt & Mcfarland Psc	KY	Family Medicine Physician	$0	$3M
Passages Of Kentucky, LLC	KY	Mental Health Counselor	$0	$2.9M
Foothills Academy, Inc.	KY	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$2.8M
Wayne County Fiscal Court	KY	Land Ambulance	$387.3K	$958.7K

Wayne County Hospital, Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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