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.

St. Louis Children's Hospital (NPI 1992727663)

Field	Value
Entity Type	Organization
Organization	St. Louis Children's Hospital
Address	1 Childrens Pl
City	Saint Louis
State	MO
ZIP	63110
Taxonomy	Children's Hospital
NPI Enumerated	July 24, 2006

Payer Source	Total Paid
Medicaid	$66.9M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused institution: there is no Medicare billing on file and lifetime Medicaid revenue is $66.9M, indicating near-exclusive reliance on Medicaid payers for the recorded activity. Analysts should treat Medicaid as the primary payer for any risk or utilization modeling of this entity given the absence of Medicare volume.

Revenue is highly concentrated in a very small set of Medicaid codes: the precomputed top three Medicaid codes (99283, Y7506, A0426) account for 45.7% of the provider’s total Medicaid revenue. In particular, 99283 alone accounts for $17.3M (28.3% of Medicaid revenue), signaling that a single emergency-department evaluation level is a dominant revenue driver.

The code mix points to a large pediatric emergency and transport operation: 99283 (ED E/M low MDM) is the top revenue code and additional ED codes (99284, 99285, 99282) appear in the top-25 list alongside ambulance transport codes A0426 and A0425. Together these codes imply substantial ED throughput and frequent non-emergency and emergency ambulance transports, consistent with a high-volume children’s hospital emergency/transfer hub.

Diagnostic and ancillary services are a notable revenue stream: high-volume lab and specialized test codes such as 85025 (CBC), 80053 (CMP), PLA code 0202U (BioFire RP2.1), 87631 (multiplex respiratory PCR), and 85045 (reticulocyte count) appear in the top-25 list. Several of these lab codes sit well above typical state volumes (0202U ranks #3 of 22 at the 90th percentile; 85045 ranks #1 of 48 at the 100th percentile), indicating institutional capacity for high-throughput and proprietary/complex testing.

The provider is a statewide leader for multiple pediatric-specific services: 99283 ranks #6 of 1263 providers in-state and is labeled an "extreme outlier," and 92567 (middle ear testing) ranks #2 of 111 providers in-state at the 99th percentile and is also an "extreme outlier." These rank positions indicate the hospital is a dominant outlier for core pediatric diagnostics and emergency evaluations within Missouri.

There are clear specialty and procedural lines beyond ED care—evidence includes 67311 (strabismus surgery), sleep study codes 95782 and 95810, and high-average-payment items such as 95782 ($5296 avg paid/claim). The presence of surgical, sleep medicine, and high-acuity diagnostic codes suggests this facility manages complex pediatric cases and provides subspecialty services that extend revenue beyond routine ED encounters.

While the institution is established—NPI enumerated on 2006-07-24 (~20 years ago)—its Medicaid revenue profile shows concentration risk: dependence on a small number of high-volume codes (top 3 = 45.7% of Medicaid revenue) could make overall revenue sensitive to fee schedule changes or shifts in ED/transport volumes. Payer strategy or utilization changes affecting ED visits, ambulance transports, or proprietary lab testing would materially affect this provider’s Medicaid revenue.

Several codes show above-typical or extreme-state-level volume for a pediatric specialty hospital: J3490 (unclassified drugs) ranks #7 of 153 at the 96th percentile, 0202U ranks #3 of 22 at the 90th percentile, and 87631 ranks #2 of 42 at the 98th percentile. These standings, together with the earlier-noted ED dominance, paint a picture of a large, specialized children’s hospital that drives outsized statewide activity for both emergency care and certain diagnostic and pharmaceutical services.

Medicaid: Complete Services Breakdown

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

137 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	62,920	$280	$17.3M
Y7506	N/A	3,320	$1,970	$6.5M
A0426	Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)	2,880	$1,430	$4.1M
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…	20,690	$200	$4M
A0425	Ground mileage, per statute mile	3,920	$840	$3.3M
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.	5,920	$520	$3.1M
X4011	N/A	7,490	$360	$2.7M
J3490	Unclassified drugs	13,510	$170	$2.3M
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.	5,460	$390	$2.1M
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	3,440	$540	$1.9M

Showing 1–10 of 137

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

St. Louis Children's Hospital — 7 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

137 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
X4011	N/A	46	110	5,700	$340	$3.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	52	100	2,240	$80	$2.2M
Y7506	N/A	36	100	980	$250	$1.6M
X4003	N/A	58	70	1,480	$80	$1.1M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	128	170	1,670	$230	$1.1M
X4006	N/A	46	50	370	$780	$969.5K
A0425	Ground mileage, per statute mile	88	200	3,230	$90	$827.5K
A0428	Ambulance service, basic life support, non-emergency transport, (bls)	47	60	880	$160	$725.7K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	82	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.	61	600	140	$170	$384.1K

Showing 1–10 of 137

Nearby Providers

Other providers in the same ZIP code as St. Louis Children's Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Council For Extended Care	MO	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$98.1M
Barnes Jewish Hospital	MO	General Acute Care Hospital	$0	$61.4M
Paraquad Inc	MO	Customized Equipment (DME)	$0	$56.3M
Washington University	MO	Multi-Specialty Clinic/Center	$0	$22M
Cooperative Home Care, Inc.	MO	Home Health Agency	$0	$20.6M
Washington University	MO	Multi-Specialty Clinic/Center	$0	$14.8M
New Beginnings In Home Services, LLC	MO	In Home Supportive Care Agency	$0	$11.6M
Washington University	MO	Multi-Specialty Clinic/Center	$0	$10.4M
Washington University	MO	Emergency Care Clinic/Center	$0	$9.1M
Bjc Home Care Services	MO	Durable Medical Equipment & Medical Supplies	$0	$8.2M

St. Louis Children's Hospital — Billing Profile & Reimbursement Data

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St. Louis Children's Hospital — 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

Nearby Providers

Frequently Asked Questions

References