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NPI 1952347981 · Marshfield, WI · Clinic/Center
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Marshfield Clinic Inc is a clinic/center provider located in Marshfield, Wisconsin. This profile covers 37 Medicare and 417 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 | Marshfield Clinic Inc |
| Address | 1000 N Oak Ave |
| City | Marshfield |
| State | WI |
| ZIP | 54449 |
| Taxonomy | Clinic/Center |
| NPI Enumerated | June 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $19.6M |
| Medicare | $526.8K |
Medicare billing is heavily weighted toward surgical pathology and ancillary pathology procedures: 88305 alone accounts for $280.7K (54.3% of this provider's Medicare revenue) and the Medicare top three pathology-related codes together make up 65.8% of Medicare revenue. High‑level pathology codes such as 88307 and immunostaining/ancillary codes like 88341 and 88342 appear throughout the top Medicare line items, indicating an embedded anatomic pathology/laboratory operation driving Medicare receipts.
The provider shows concentrated Medicare revenue: the precomputed top‑3 share of 65.8% signals that a small set of pathology codes dominate Medicare income, with 88305 ($280.7K) as the single largest Medicare contributor. Within those top codes, 88307 is flagged as an "extreme outlier, far above typical national volume for this code," and several other pathology codes are described as "notably above typical" or at high percentiles nationally, reinforcing the concentration in specialized lab services.
On the Medicaid side, ambulatory evaluation & management and high‑volume testing are primary revenue drivers: 99214 accounts for $3.6M (26.9% of Medicaid revenue), U0003 for $2.4M (17.4%), and 99213 for $1.3M (10.0%); these three codes sum to the precomputed 54.3% of Medicaid revenue. The Medicaid profile therefore reflects large volumes of office visits and COVID PCR testing alongside substantial diagnostic lab work (88305 also contributes $1.3M to Medicaid revenue), consistent with a broad ambulatory care footprint that includes on‑site or affiliated lab capacity.
The provider’s payer mix is strongly weighted toward Medicaid at scale: total Medicaid revenue is $19.6M compared with total Medicare revenue of $526.8K, indicating Medicaid is the dominant source of billed revenue for this entity. This imbalance implies operational priorities, patient mix, and contracting leverage will look very different than a provider with Medicare‑heavy revenue.
Competitive standing is strong for multiple high‑volume codes at different geographic scales: for Medicare 88305 ranks at the 98th percentile nationally and 88307 is a 99th‑percentile "extreme outlier," signaling nationally elevated pathology volume; for Medicaid 99214 ranks #13 of 1628 in‑state (99th percentile, "extreme outlier") and U0003 ranks #3 of 172 in‑state (99th percentile, "notably above typical"), marking the provider as a major in‑state participant for office E&M and high‑throughput COVID testing. These rank/percentile signals suggest the provider is a leading regional player for ambulatory visits and testing while also punching above typical national volumes for selected pathology services.
The cross‑payer appearance of pathology code 88305 (a top Medicare code at $280.7K and a top Medicaid code at $1.3M) highlights a vertically integrated lab/service line that serves both payer populations. This pattern—high 88305 volume on Medicaid and Medicare—suggests the lab contributes materially to overall throughput and should be a focus for capacity, pricing, and peer benchmarking conversations.
NPI tenure indicates organizational longevity: the NPI was enumerated 2006‑06‑20 (~20 years ago), supporting the interpretation that high volumes and established rank positions are likely the result of sustained operations rather than a short‑term spike. Long tenure combined with the volume patterns supports planning assumptions around stable referral relationships and operational scale.
Several codes are identified as statistical outliers or notably above typical volumes and therefore warrant targeted review for contract negotiations, network planning, or benchmarking: Medicare 88307 is an "extreme outlier, far above typical national volume for this code," Medicare 88305 and related pathology codes are "notably above typical," and Medicaid 99214 and U0003 are in the 99th/very high percentiles in‑state. These flagged codes represent the clearest levers for payer discussions on reimbursement, utilization management, and comparative performance analysis without implying any improper activity.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
37 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 10,800 | $30 | $280.7K |
| 88307 | The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 490 | $60 | $30.6K |
| 88341 | The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified… | 1,370 | $20 | $28.8K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 990 | $30 | $25.7K |
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method | 180 | $130 | $23.4K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 40 | $380 | $15.4K |
| 88112 | Selective cellular enhancement for cytopathology, such as the method of using a liquid–based slide preparation, uses a liquid–based medium to collect samples and preserve cells which can aid in… | 630 | $20 | $12.6K |
| 88360 | The lab analyst applies a single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist, evaluates the… | 350 | $30 | $11.3K |
| 88173 | The lab analyst performs the technical lab test to analyze a cytopathology specimen from a fine needle aspirate and then interprets and reports the results. | 180 | $50 | $9.2K |
| 88309 | The physician, typically a pathologist, performs a level VI examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 80 | $110 | $8.6K |
Showing 1–10 of 37
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 37 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
417 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… | 107,080 | $30 | $3.6M |
| 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… | 31,840 | $70 | $2.4M |
| 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… | 56,160 | $20 | $1.3M |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 28,030 | $50 | $1.3M |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 8,960 | $50 | $475.1K |
| 90960 | The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the… | 5,920 | $70 | $426K |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 7,330 | $50 | $388.4K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 10,470 | $30 | $324.6K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 11,040 | $30 | $298.2K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 9,170 | $30 | $284.2K |
Showing 1–10 of 417
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
417 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 174 | 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. | 155 | 430 | 760 | $60 | $484.6K |
| 99282 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making. | 146 | 190 | 1,790 | $90 | $390.9K |
| 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. | 171 | 330 | 1,350 | $60 | $338K |
| 90960 | The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the… | 5 | 30 | 1,050 | $70 | $320.9K |
| 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… | 3 | 170 | 720 | $70 | $272.7K |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 10 | 20 | 510 | $70 | $255.3K |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 54 | 80 | 650 | $110 | $244.4K |
| 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. | 56 | 260 | 3,590 | $20 | $232.2K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 25 | 190 | 620 | $40 | $226.6K |
Showing 1–10 of 417
Other providers in the same ZIP code as Marshfield Clinic Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Family Health Center Of Marshfield Inc | WI | Federally Qualified Health Center (FQHC) | $0 | $3.4M |
| Family Health Center Of Marshfield Inc | WI | Federally Qualified Health Center (FQHC) | $0 | $3.2M |
| Marriage & Family Health Services, Ltd. | WI | Adolescent and Children Mental Health Clinic/Center | $0 | $2.6M |
| Mchs Hospitals Inc | WI | Land Ambulance | $1.4M | $987.9K |
| School District Of Marshfield | WI | Local Education Agency (LEA) | $0 | $1.7M |
| Total Renal Care Inc | WI | End-Stage Renal Disease (ESRD) Treatment Clinic/Center | $0 | $1.3M |
| City Of Marshfield | WI | Land Ambulance | $200K | $484.6K |
| Lori Bents | WI | Chiropractor | $27.4K | $399.4K |
| Yan Guo | WI | Ophthalmology Physician | $318.7K | $0 |
| Yi Hsieh | WI | Urology Physician | $299K | $0 |
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