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NPI 1922043744 · Madison, WI · General Acute Care Hospital
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University Of Wisconsin Hospitals And Clinics Authority is a general acute care hospital provider located in Madison, Wisconsin. This profile covers 0 Medicare and 963 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | University Of Wisconsin Hospitals And Clinics Authority |
| Address | 600 Highland Ave |
| City | Madison |
| State | WI |
| ZIP | 53792 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | June 17, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $120M |
| Medicare | $0 |
This provider is effectively single-payer in the available data: there is no Medicare billing on file, while total Medicaid revenue is $120M. The absence of Medicare billing on file indicates analyses should focus on Medicaid performance and competitive standing rather than Medicare-related benchmarks for this entity.
Revenue is highly concentrated in a small set of outpatient and case‑management codes: the precomputed top 3 Medicaid codes (99213, 99214, T2023) account for 45.8% of the provider's total Medicaid revenue. Specifically, 99213 accounts for $18M (25.7% of Medicaid revenue), 99214 for $7.3M (10.4%), and T2023 for $6.8M (9.7%), so evaluation of outpatient E/M and targeted case management performance will explain nearly half of Medicaid receipts.
The mix of high‑revenue codes points to a large outpatient and acute care operation: dominant E/M codes 99213 (273.1K claims) and 99214 (84.6K claims) sit alongside high-volume emergency visit codes 99283/99284/99285 and frequent infusion/IV administration codes 96360/96361/96365. This combination suggests the provider operates extensive ambulatory clinics plus a busy emergency and infusion service line rather than being limited to narrow specialty care.
Competitive standing within the state is strong and often extreme: 99213 ranks #3 of 1755 providers in‑state (100th percentile; extreme outlier) and 99214 ranks #21 of 1628 (99th percentile). Several other service lines are similarly dominant—87635 (SARS–CoV‑2 NAAT) ranks #1 of 261 providers (100th percentile, extreme outlier) and 70553 (brain MRI with/without contrast) ranks #1 of 85 providers (100th percentile, extreme outlier)—indicating the provider is a major statewide player across clinic visits, lab testing, and imaging.
Telehealth and transport services are notable outliers: Q3014 (telehealth originating site facility fee) generates $1.7M and ranks #2 of 167 providers (99th percentile; extreme outlier), while air transport codes A0431 and A0436 both rank #1 of 6 providers in‑state (100th percentile). These patterns point to substantial originating‑site telehealth activity and significant use of air ambulance services in the provider's Medicaid billing.
Infusion and ED throughput are material revenue drivers beyond office visits: 96365 ($2.5M, rank #2 of 135, 99th percentile; extreme outlier), 96361 ($4.9M, rank #4 of 135, 98th percentile; extreme outlier), and bundled ED E/M codes (99283–99285 collectively contributing multiple millions) reflect a high volume of IV medication/fluids and acute episodic care. This suggests capacity and billing intensity in infusion therapy and emergency department throughput.
Not all high-revenue codes are exceptional statewide; the data contain a mix of statistical labels that temper interpretation. While many codes are labeled "extreme outlier" or "notably above typical" (e.g., 99213, 87635, 70553), others such as T2023 (rank #2 of 4, 67th percentile; typical, unremarkable volume) and 77386 (rank #3 of 3; 0th percentile; typical, unremarkable) show routine or unremarkable standing—so analysts should prioritize the extreme outliers when assessing competitive displacement and capacity.
The provider has an established operational tenure: NPI enumerated 2006-06-17 (~20 years ago), indicating a sustained presence in the market. Coupled with the heavy Medicaid revenues and repeated top‑percentile ranks across multiple service lines, the listing suggests a long-standing institution with entrenched Medicaid-facing ambulatory, ED, diagnostic, and transport services.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
963 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… | 273,070 | $70 | $18M |
| 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… | 84,560 | $90 | $7.3M |
| T2023 | Targeted case management; per month | 16,280 | $420 | $6.8M |
| 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. | 42,390 | $120 | $4.9M |
| 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. | 45,830 | $60 | $2.7M |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 42,600 | $60 | $2.7M |
| 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. | 46,440 | $60 | $2.6M |
| A0431 | Ambulance service, conventional air services, transport, one way (rotary wing) | 1,740 | $1,460 | $2.5M |
| 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. | 79,590 | $30 | $2.5M |
| 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. | 34,230 | $70 | $2.5M |
Showing 1–10 of 963
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
963 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T2023 | Targeted case management; per month | 2 | 10 | 10,060 | $410 | $6.6M |
| J9271 | Injection, pembrolizumab, 1 mg | 4 | 10 | 200 | $1,270 | $1.4M |
| 77386 | Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex | 3 | 10 | 8,330 | $140 | $1.4M |
| 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. | 4 | 140 | 3,200 | $160 | $1.1M |
| A0431 | Ambulance service, conventional air services, transport, one way (rotary wing) | 1 | 10 | 530 | $1,490 | $1.1M |
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg | 5 | 10 | 2,330 | $400 | $916.4K |
| P9016 | Red blood cells, leukocytes reduced, each unit | 4 | 10 | 750 | $590 | $906.4K |
| J0588 | Injection, incobotulinumtoxin a, 1 unit | 1 | 10 | 1,370 | $280 | $624.7K |
| 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. | 11 | 360 | 1,550 | $70 | $614.4K |
| 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. | 11 | 430 | 760 | $60 | $484.6K |
Showing 1–10 of 963
Other providers in the same ZIP code as University Of Wisconsin Hospitals And Clinics Authority, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| David Lewis | WI | Ophthalmology Physician | $1.4M | $0 |
| Jagroop Basraon | WI | Clinical Cardiac Electrophysiology Physician | $1.1M | $0 |
| Rakesh Mandal | WI | Clinical Pathology/Laboratory Medicine Physician | $67.1K | $547.9K |
| Daniel Guerra Rodas | WI | Nephrology Physician | $147.6K | $462.1K |
| Ali Pirasteh | WI | Diagnostic Radiology Physician | $498.3K | $0 |
| Robert Hegeman | WI | Medical Oncology Physician | $393.7K | $0 |
| Michael Christopher | WI | Dermatology Physician | $386K | $0 |
| Mark Mounajjed | WI | Infectious Disease Physician | $381.5K | $0 |
| Christine Vetter | WI | Diagnostic Radiology Physician | $367.5K | $0 |
| Scott Perlman | WI | Nuclear Imaging & Therapy Physician | $351.6K | $0 |
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