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

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

Ssm Health Care St. Louis (NPI 1962572396)

Field	Value
Entity Type	Organization
Organization	Ssm Health Care St. Louis
Address	6420 Clayton Rd
City	Saint Louis
State	MO
ZIP	63117
Taxonomy	General Acute Care Hospital
NPI Enumerated	November 9, 2006

Payer Source	Total Paid
Medicaid	$50.1M
Medicare	$0

Key Findings

Provider is effectively a Medicaid-only billing entity: there is no Medicare billing on file while total Medicaid revenue is $50.1M, and the NPI was enumerated on 2006-11-09 (~20 years ago), indicating an established presence in the market but concentrated exposure to Medicaid reimbursement. This single-payer orientation should be a primary lens for any revenue or risk assessment.

Revenue concentration is high within a small set of codes: the top 3 Medicaid codes by revenue account for 38.0% of this provider's total Medicaid revenue, with X4011 reported at $7.6M (17.3% of Medicaid revenue), G0463 at $5.5M (12.6%), and X4003 at $3.5M (8.1%). Analysts should treat changes to payment policy or utilization for these specific codes as material to the provider’s financials.

Operational footprint implied by the code mix points to a large hospital-based outpatient and emergency operation with embedded lab and obstetric services. High volumes and revenues for G0463 (66.2K claims, $5.5M) indicate substantial hospital outpatient clinic activity; ED E/M codes 99284 (15.7K claims, $2.8M), 99283 (19.7K claims, $2.7M) and 99285 (5.3K claims, $1.4M) reflect heavy emergency department throughput; and numerous high-volume lab codes (85025, 80053, G0480, 87808, 87591, 87389, 87491) show significant in-house laboratory testing.

The provider is a major emergency department volume player statewide for moderate- and low-complexity visits: 99284 ranks #32 of 953 providers in-state (97th percentile; notably above typical state volume) and 99283 ranks #30 of 1263 providers in-state (98th percentile; notably above typical state volume). While 99285 is lower at the 89th percentile (rank #66 of 596), the overall ED mix signals a strong role in unscheduled acute care for Medicaid patients.

Laboratory and diagnostic services are a standout competitive strength relative to in-state peers. 85025 (CBC) appears as an extreme outlier at rank #9 of 324 providers in-state (98th percentile; extreme outlier, far above typical state volume) and 80053 (CMP) ranks #9 of 242 (97th percentile; notably above typical state volume); in addition, 87808 ranks #1 of 8 providers in-state (100th percentile; notably above typical state volume), indicating differentiated lab throughput and capacity.

Obstetric imaging and fetal monitoring are prominent lines of business: 76816 (reexamination fetal ultrasound) shows 10.4K claims and $1.6M revenue (rank #7 of 193, 97th percentile; notably above typical state volume), 59025 (fetal heart rate testing) reports 4.4K claims and $1.6M revenue (rank #6 of 180, 97th percentile; notably above typical state volume), and 76815 ranks #3 of 151 (99th percentile; notably above typical state volume). These patterns point to a robust maternity imaging and monitoring service mix serving Medicaid patients.

Outpatient observation and administered therapies contribute meaningfully to Medicaid revenue and suggest capacity for short-stay and infusion services: G0378 (hospital observation per hour) generated $412.6K (953 claims, rank #7 of 50, 88th percentile; typical, unremarkable volume) and 96374 (IV push) generated $841.4K (8.2K claims, rank #8 of 90, 92th percentile; typical, unremarkable volume). Together with the high outpatient clinic volume (G0463), these codes reinforce the provider’s role in ambulatory and observation-level care.

Concentration and code-description gaps are practical areas for underwriting and network-review attention: the top three revenue drivers include two codes with no descriptions (X4011 and X4003), and those high-revenue, high-percentile codes should be validated for clinical mix and billing alignment given they collectively drive a large share of the $50.1M Medicaid revenue. Given the provider’s reliance on Medicaid and the 38.0% concentration in three codes, payer negotiations or policy changes affecting those codes would likely have outsized impact on the organization’s Medicaid revenue profile.

Medicaid: Complete Services Breakdown

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

159 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
X4011	N/A	29,480	$260	$7.6M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	66,200	$80	$5.5M
X4003	N/A	25,250	$140	$3.5M
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	70,370	$50	$3.2M
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.	15,690	$180	$2.8M
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.	19,710	$140	$2.7M
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.	50,020	$40	$2.2M
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	10,360	$160	$1.6M
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.	8,680	$190	$1.6M
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	4,380	$360	$1.6M

Showing 1–10 of 159

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

Ssm Health Care St. Louis — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

159 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
X4011	N/A	8	110	5,700	$340	$3.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	10	100	2,240	$80	$2.2M
Y7506	N/A	70	100	980	$250	$1.6M
X4003	N/A	9	70	1,480	$80	$1.1M
X4006	N/A	9	50	370	$780	$969.5K
Y7507	N/A	42	50	270	$360	$594.9K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	8	90	1,850	$120	$384.1K
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.	66	600	140	$170	$384.1K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	10	110	2,100	$70	$364.3K
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.	9	240	1,740	$40	$353.4K

Showing 1–10 of 159

Related Providers

Other providers that share a Tax Identification Number (TIN) with Ssm Health Care St. Louis, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$27.7M
Ssm Medical Group, Inc.	MO	Multi-Specialty Clinic/Center	$0	$19.4M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$12.4M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$8.9M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$7.7M
Ssm Cardinal Glennon Childrens Hospital	IL	Pediatrics Physician	$0	$5.4M
Lewis Meyerson	MO	Family Medicine Physician	$340.9K	$18K
Adam Schulte	MO	Physical Medicine & Rehabilitation Physician	$328.7K	$2.4K
Usman Qayyum	MO	Interventional Cardiology Physician	$188.5K	$107.8K
Khaled Abdel-hamid	MO	Allergy & Immunology Physician	$279.6K	$15.1K

Nearby Providers

Other providers in the same ZIP code as Ssm Health Care St. Louis, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
5 Star Home Care Services LLC	MO	Home Health Agency	$0	$9.3M
Medstar Home Health Services LLC	MO	Home Health Agency	$0	$7.3M
Cep America LLC	MO	Emergency Medicine Physician	$0	$4M
Nicholas Chinskey	MO	Ophthalmology Physician	$2.5M	$0
Raymond Leung	MO	Internal Medicine Physician	$15.6K	$429.9K
Waseem Ansari	MO	Ophthalmology Physician	$434.7K	$0
Kelvin Mcdaniel	MO	Ophthalmology Physician	$363K	$0
Sean Breit	MO	Ophthalmology Physician	$357.5K	$0
Paul Catanzaro	MO	Internal Medicine Physician	$316.1K	$0
Jeramie Rosales Rodriguez	MO	Psychiatry Physician	$2.1K	$289.9K

Ssm Health Care St. Louis — 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