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

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

Adena Health System (NPI 1902839673)

Key Findings

Field	Value
Entity Type	Organization
Organization	Adena Health System
Address	272 Hospital Rd
City	Chillicothe
State	OH
ZIP	45601
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 8, 2006

Payer Source	Total Paid
Medicaid	$98M
Medicare	$0

ADENA HEALTH SYSTEM is effectively a single-payer Medicaid facility in the available data: there is no Medicare billing on file while total Medicaid revenue is $98M, indicating that Medicaid accounts for the entire reported lifetime federal payer revenue. This concentration means analyses and risk/volume assessments should focus on Medicaid utilization patterns rather than Medicare mix.

Revenue concentration is high: the precomputed top 3 Medicaid codes account for 51.4% of ADENA’s total Medicaid revenue, signaling that a small set of services drives more than half of its Medicaid receipts. This degree of dependence on a few codes increases operational sensitivity to changes in reimbursement, utilization review, or coding guidance for those services.

The single largest Medicaid revenue driver is G0463 (hospital outpatient clinic visit), which generated $14.4M and represents 20.3% of the provider’s Medicaid revenue. G0463 ranks #8 of 151 in-state (95th percentile), a solid statewide placement that suggests a well-established outpatient clinic footprint and routine outpatient assessment volume relative to peers.

ADENA is an extreme statewide outlier on 99212: 140.9K claims produced $13M (18.3% of Medicaid revenue) and the provider ranks #3 of 1608 in-state (100th percentile). That unusually high volume for a low-complexity established-patient office visit suggests heavy ambulatory outpatient throughput, potentially reflecting broad access for established patients or administrative factors that drive many short/straightforward visits.

The provider also shows elevated volumes for moderate-complexity outpatient evaluation and management: 99214 accounted for $9.1M (12.8% of Medicaid revenue) and ranks in the 99th percentile statewide. Together with 99212 and 99213 ($5.8M, 8.1%), the E/M mix indicates ADENA’s business is dominated by ambulatory evaluation and management visits across low-to-moderate complexity levels rather than high-acuity inpatient procedures.

Emergency department E/M codes appear as important but smaller revenue contributors: 99283, 99284, and 99285 collectively appear in the top codes and together represent a meaningful portion of volume (individual revenues $4.7M, $3.7M, and $2.1M respectively). Their percentile ranks (86th, 85th, and 84th) place ADENA above typical state volume but not dominant, consistent with a hospital that maintains a busy ED but whose primary Medicaid revenue drivers remain outpatient clinic and office E/M visits.

Service-line breadth includes substantial therapy, imaging, observation, and procedure activity: high-ranking codes such as 97110 and 97530 (therapy), CT and CTA imaging codes (74177, 74176, 71275, 70450), observation G0378, and several infusion and injection codes (96365/96366/96361, 20610) illustrate a mixed acute care and outpatient rehabilitation/care-management model. This mix supports a general acute care hospital that also operates high-volume outpatient and ancillary services.

ADENA’s NPI enumeration date (~2006-07-08, ~20 years ago) indicates long tenure in the market, which aligns with its broad service footprint and the high volumes reported across numerous Medicaid codes. That longevity, coupled with concentrated Medicaid revenue, suggests established referral patterns and operational stability within the state Medicaid network.

Several individual codes are flagged as notably above typical or high-percentile volumes beyond the extreme outlier 99212: 99214 (99th), 97110 (97th), 95886 (98th), and G0378 (92nd). These statistical labels indicate ADENA is a significant statewide provider for therapeutic, neurodiagnostic, and observation services; payers and network planners should treat those lines as locally important when evaluating capacity, contracting, or utilization management initiatives.

Medicaid: Complete Services Breakdown

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

694 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	215,040	$70	$14.4M
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,…	140,880	$90	$13M
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…	85,990	$110	$9.1M
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…	55,090	$110	$5.8M
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.	43,650	$110	$4.7M
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.	31,630	$120	$3.7M
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.	20,410	$100	$2.1M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	32,340	$60	$2.1M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	17,140	$100	$1.7M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	12,910	$110	$1.4M

Showing 1–10 of 694

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Adena Health System — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

694 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	8	150	4,030	$100	$5.9M
J9271	Injection, pembrolizumab, 1 mg	17	20	360	$8,480	$5M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	109	170	4,660	$300	$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.	68	480	4,510	$90	$1.8M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	15	20	480	$730	$1.6M
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.	98	660	460	$90	$1.5M
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.	93	580	510	$100	$1.3M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	33	140	1,130	$90	$1.1M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	27	80	100	$860	$719.1K
J0585	Injection, onabotulinumtoxina, 1 unit	35	60	250	$730	$707.7K

Showing 1–10 of 694

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Adena Medical Group LLC	OH	Family Medicine Physician	$0	$39.9M
Terry Kaylor	OH	Gastroenterology Physician	$77.8K	$0
Adam Hanje	OH	Transplant Hepatology Physician	$41.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Scioto Paint Valley Mental Health Center	OH	Multi-Specialty Clinic/Center	$0	$17.4M
Wise Medical Staffing, Inc.	OH	Home Health Agency	$0	$12.8M
Scioto Paint Valley Mh Ctr	OH	Multi-Specialty Clinic/Center	$0	$9.5M
National Church Residences At Home Hospice	OH	Community Based Hospice Care Agency	$0	$8.9M
Safe Haven Darts,llc	OH	Case Management Agency	$0	$8.2M
Family Urgent Care, LLC.	OH	Urgent Care Clinic/Center	$0	$7.9M
Pinnacle Treatment Centers Oh-ii, LLC	OH	Methadone Clinic	$145.6K	$7.1M
Ross County Home Health LLC	OH	Home Health Agency	$0	$7M
Rahul Kar	OH	Vascular Surgery Physician	$2M	$0
City Of Chillicothe	OH	Land Ambulance	$324K	$1.5M

Adena Health System — 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