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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Duke University Health System, Inc. (NPI 1992703540)

Key Findings

Field	Value
Entity Type	Organization
Organization	Duke University Health System, Inc.
Address	2301 Erwin Road
City	Durham
State	NC
ZIP	27710
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 8, 2005

Payer Source	Total Paid
Medicaid	$44.4M
Medicare	$0

DUKE UNIVERSITY HEALTH SYSTEM, INC. is effectively single-payer in these data: Total Medicare revenue is none (no Medicare billing on file), while Total Medicaid revenue is $44.4M. The absence of Medicare claims on file means the provider’s public-billing footprint in these records is dominated by Medicaid activity and should be analyzed accordingly rather than as a dual-payer profile.

Revenue concentration within Medicaid is pronounced: the precomputed top three Medicaid codes (99212, 99285, 99283) account for 50.1% of the provider’s total Medicaid revenue. This indicates that a small set of evaluation-and-management and emergency visit codes are the primary revenue drivers for this provider under Medicaid.

Operational mix implied by the top revenue codes points to high outpatient and emergency-department throughput. Code 99212 (189.2K claims, $6.2M, 18.1%) is an office/outpatient E/M for established patients and is the single largest Medicaid revenue source; codes 99285 (16.8K claims, $6.2M, 17.9%) and 99283 (23.1K claims, $4.9M, 14.1%) are high- and moderate/low-acuity ED E/M codes respectively, together showing the organization bills heavily for both routine outpatient visits and a wide range of ED acuity.

Competitive standing for 99212 is exceptional: the provider ranks #1 of 1060 in-state (100th percentile; extreme outlier) on volume for that code, signaling dominant outpatient visit volume relative to state peers. By contrast, 99285 ranks #58 of 281 (80th percentile; typical, unremarkable volume) and 99283 ranks #80 of 316 (75th percentile; typical, unremarkable volume), meaning ED services generate large Medicaid dollars for DUKE but its ED volumes are sizeable yet more in-line with other hospitals statewide for those specific ED codes.

Obstetrics and fetal imaging are notable service lines in the Medicaid mix. Fetal monitoring 59025 (14.2K claims, $806.6K, 2.3%) ranks #6 of 173 (97th percentile; notably above typical state volume), while ultrasound follow-ups and limited exams (76816, 76815, 76811) appear among the top codes with multi-hundred-thousand-dollar revenues, indicating a busy maternal-fetal/imaging practice under Medicaid.

High-volume laboratory and infectious-disease testing are significant and concentrated in pandemic-era and routine lab codes. COVID testing codes U0003 (19.4K claims, $1.7M, 5.0%), U0002 (13K claims, $648.5K, 1.9%), and U0005 (19.9K claims, $597.5K, 1.7%) are all in high state percentiles (e.g., U0003 ranks #13 of 158, 92th percentile), and routine panels like 85025 (60.1K claims, $480.8K, 1.4%) and 80053 (47.8K claims, $478.5K, 1.4%) show heavy lab throughput and diagnostic volume.

Presence of high-unit-value specialty items and diagnostic cardiology suggests advanced ambulatory and specialty services. J0585 onabotulinumtoxina (608 claims, $814.7K, 2.4%) ranks #4 of 15 (79th percentile) indicating a concentrated but high-revenue specialty procedure; transthoracic echo codes 93306 (1.5K claims, $554.7K, 1.6%) and 93303 (1K claims, $459.5K, 1.3%) further point to cardiology imaging capacity in the Medicaid population.

The provider has longstanding enrollment: NPI enumerated (registered) 2005-07-08 (~21 years ago). Coupled with the dominant 99212 volume and high rankings on multiple Medicaid codes, this tenure supports interpretation of DUKE as an established regional provider with entrenched outpatient, ED, maternal-fetal, lab, and specialty service lines in the Medicaid market.

Medicaid: Complete Services Breakdown

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

363 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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,…	189,160	$30	$6.2M
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.	16,820	$370	$6.2M
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.	23,100	$210	$4.9M
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.	10,210	$300	$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…	19,440	$90	$1.7M
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…	31,190	$40	$1.3M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	20,350	$70	$1.3M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	15,210	$70	$1.1M
J0585	Injection, onabotulinumtoxina, 1 unit	610	$1,340	$814.7K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	14,150	$60	$806.5K

Showing 1–10 of 363

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Duke University Health System, Inc. — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

363 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	5	10	110	$5,750	$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.	132	330	6,130	$130	$2.7M
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	25	30	170	$260	$2.6M
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…	13	160	840	$70	$2.3M
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.	80	320	6,160	$120	$2.1M
G0483	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…	66	110	1,450	$110	$1.7M
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.	58	280	2,690	$130	$1.6M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	164	640	4,280	$60	$983.2K
86003	The lab analyst performs the technical lab test to analyze a specimen such as serum for allergen–specific immunoglobulin E (IgE), using a crude allergen extract. The test result is quantitative or…	16	40	220	$60	$920.5K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	23	40	420	$1,080	$841K

Showing 1–10 of 363

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jonathan Cook	NC	Dermatology Physician	$1.6M	$0
Tywana Donaldson	NC	Nurse Practitioner	$1.4M	$0
Pretesh Patel	NC	Radiation Oncology Physician	$668.8K	$0
Pedro Vargas	NC	Diagnostic Radiology Physician	$439.5K	$0
Michael Rehorn	NC	Student in an Organized Health Care Education/Training Program	$369.4K	$0
Christopher Brown	NC	Orthopaedic Surgery Physician	$360.8K	$0
Sunit Vekaria	NC	Diagnostic Radiology Physician	$358.3K	$0
Priyatham Mettu	NC	Ophthalmology Physician	$332.6K	$0
Christopher Boehlke	NC	Ophthalmology Physician	$314.3K	$0
Leon Herndon	NC	Ophthalmology Physician	$264K	$0

Duke University Health System, Inc. — Billing Profile & Reimbursement Data

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Duke University Health System, Inc. — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Private Diagnostic Clinic, PLLC	NC	General Practice Physician	$0	$46.5M
Duke Health Integrated Practice, Inc.	NC	General Practice Physician	$0	$36.3M
Duke University Health System, Inc.	NC	General Acute Care Hospital	$0	$11.6M
Duke University Affiliated Physicians, Inc.	NC	Emergency Medicine Physician	$0	$11.6M
Duke University Health System, Inc.	NC	Parenteral & Enteral Nutrition Supplies (DME)	$0	$8.3M
Duke University Health System Inc	NC	General Acute Care Hospital	$0	$7.9M
Duke University Health System, Inc.	NC	Internal Medicine Physician	$0	$7.6M
Majda Hadziahmetovic	NC	Ophthalmology Physician	$2.3M	$0
Michael Allingham	NC	Retina Specialist (Ophthalmology) Physician	$1.7M	$0
Associated Health Services, Inc.	NC	Ambulatory Surgical Clinic/Center	$1.6M	$102.4K