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

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

Helena Orthopaedic Clinic (NPI 1902823917)

Helena Orthopaedic Clinic is a orthopaedic surgery physician provider located in Helena, Montana. This profile covers 0 Medicare and 13 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	Helena Orthopaedic Clinic
Address	2442 Winne Ave
City	Helena
State	MT
ZIP	59601
Taxonomy	Orthopaedic Surgery Physician
NPI Enumerated	July 16, 2006

Payer Source	Total Paid
Medicaid	$470.3K
Medicare	$0

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	2,460	$70	$181.9K
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…	2,840	$60	$164.8K
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…	630	$110	$69.9K
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…	260	$100	$26.7K
99204	The provider sees a new 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 provider…	90	$160	$14.9K
95886	The provider assesses the electrical activity of a muscle in the extremity and related paraspinal areas. At the same session as a separately reportable nerve conduction study. He studies five or more…	70	$150	$10K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	10	$80	$910
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	20	$40	$810
99442	N/A	10	$20	$290
99000	Use this code for the in office preparation of a specimen for lab analysis and or its transport from the office to the outside testing laboratory.	30	$0	$0

Showing 1–10 of 13

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Helena Orthopaedic Clinic — 0 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	122	530	580	$70	$224.6K
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…	145	520	730	$40	$196.4K
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…	50	160	250	$110	$85.9K
99204	The provider sees a new 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 provider…	68	130	100	$120	$49.4K
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…	70	190	130	$70	$37.2K
95886	The provider assesses the electrical activity of a muscle in the extremity and related paraspinal areas. At the same session as a separately reportable nerve conduction study. He studies five or more…	14	20	190	$80	$34.3K
A4215	Needle, sterile, any size, each	28	40	140	$40	$10.5K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	98	100	60	$40	$10.3K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	210	240	170	$1	$10.3K
99442	N/A	40	40	50	$10	$2.3K

Showing 1–10 of 13

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Erik Bergquist	MT	Orthopaedic Surgery Physician	$114.2K	$0
Aaron Cross	MT	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$107.6K	$0
Kelli Sebestyen	MT	Medical Physician Assistant	$76.9K	$0
Peter Hanson	MT	Orthopaedic Surgery Physician	$72.7K	$0
Kelli Carman	MT	Physician Assistant	$67.3K	$0
Brittany Miner	MT	Medical Physician Assistant	$60.7K	$0
Jamie Shafer	MT	Otolaryngic Allergy Physician	$57K	$0
Salvatore Giovenco	MT	Physician Assistant	$50.6K	$0
Lindsey Maierle	MT	Physician Assistant	$48.7K	$0
Austen Sparrow	MT	Physician Assistant	$35.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Mont	MT	Adult Care Home Facility	$0	$34.7M
Intermountain Deaconess Home	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$11.9M
County Of Lewis & Clark Lewis & Clark County School District #1	MT	Local Education Agency (LEA)	$0	$10.8M
Pediatric Dentistry PC	MT	Pediatric Dentistry	$0	$9.9M
Montana Children's Home & Hospital	MT	General Acute Care Hospital	$0	$8.7M
Region Iv Family Outreach, Inc	MT	Case Manager/Care Coordinator	$0	$7.3M
Lewis And Clark Emergency Physicians P C	MT	Emergency Medicine Physician	$0	$6.6M
Montana Independent Living Project	MT	In Home Supportive Care Agency	$0	$6M
St. Peter's Health	MT	Family Medicine Physician	$0	$5.2M
Edgewood Helena Senior Living LLC	MT	Assisted Living Facility	$0	$4.7M

Helena Orthopaedic Clinic — Billing Profile & Reimbursement Data

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Helena Orthopaedic Clinic — 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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