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

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

Hca Health Services Of Tennessee, Inc. (NPI 1992776405)

Field	Value
Entity Type	Organization
Organization	Hca Health Services Of Tennessee, Inc.
Address	200 Stonecrest Blvd
City	Smyrna
State	TN
ZIP	37167
Taxonomy	General Acute Care Hospital
NPI Enumerated	February 1, 2006

Payer Source	Total Paid
Medicaid	$28.2M
Medicare	$0

Key Findings

This entity is effectively a Medicaid-focused hospital: there is no Medicare billing on file and reported lifetime Medicaid revenue is $28.2M, indicating a single-payer footprint in the available data. The provider’s top three Medicaid codes account for 94.2% of that Medicaid revenue, showing heavy dependence on a very small set of services for the majority of its payer income.

The revenue and claim mix point to a high-throughput emergency department operation: 99283 (ED visit, low MDM) generated $13.9M from 52.2K claims and 99284 (ED visit, moderate MDM) generated $11.4M from 42.2K claims, together representing the dominant clinical activity. Secondary ED codes such as 99282 and 99285 also appear in the file, reinforcing that evaluation-and-management ED services are the core service line driving Medicaid revenue.

Revenue concentration is extreme: the single codes 99283 and 99284 alone represent 49.5% and 40.6% of the provider’s Medicaid revenue respectively, and when combined with 96374 (4.1%) they make up the precomputed 94.2% concentration. That degree of concentration signals material business risk if ED volumes or reimbursement for those specific codes change.

Competitive standing within Tennessee is strong for several high-volume codes: 99283 ranks #24 of 611 providers in-state (96th percentile) and is explicitly described as "notably above typical state volume," which positions the provider as a major regional deliverer of that level of ED care. 99284 ranks #30 of 625 (95th percentile) and is described as having typical, unremarkable volume despite the high rank, while 96374 ranks #5 of 121 (97th percentile) and is also "notably above typical state volume," indicating market-leading use of IV push administration relative to peers.

The billing pattern shows extensive ancillary and laboratory activity with many high-count codes that report $0 average paid/claim and $0 revenue (examples include 85027 at 42.6K claims, 93005 at 18K claims, 81001 at 17.8K claims, and 71045 at 13.3K claims). These zero-revenue lines likely reflect billing practices where lab and some diagnostic items are captured on claims but are paid via bundled payments or not reimbursed separately by Medicaid; the pattern suggests heavy use of standard ED labs and diagnostics with limited standalone Medicaid revenue capture.

The provider shows substantial parenteral medication administration activity: 96374 has 23.5K claims and $1.1M revenue, while related codes 96375 (5.5K claims) and 96372 (2.1K claims) are also present even though their average paid amounts are low. This combination supports an operational profile in which IV/IM medication administration is a frequent adjunct to ED E/M visits rather than a separately lucrative service line.

The NPI was enumerated on 2006-02-01 (~20 years ago), indicating long-standing enrollment and operational tenure in the market; that multi-year presence is consistent with the large cumulative claim volumes observed across ED and ancillary codes. Longevity combined with top-percentile ranks for core ED codes suggests an established referral and catchment pattern in the Smyrna, TN area.

There are several statistical outliers in utilization relative to peers that merit attention for network and utilization reviews: J1885 shows 9.6K claims and is labeled an "extreme outlier, far above typical state volume" despite $0 avg paid/claim and $0 revenue, and codes such as 81025 (13.5K claims), 83690 (13.1K claims), and 85027 (42.6K claims) are described as "notably above typical state volume." These entries point to unusually high reported usage of certain injections and lab tests compared with in-state peers, even where they do not generate standalone Medicaid revenue.

Medicaid: Complete Services Breakdown

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

79 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.	52,210	$270	$13.9M
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.	42,200	$270	$11.4M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	23,450	$50	$1.1M
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.	6,150	$170	$1M
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…	5,610	$30	$173.8K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	240	$340	$81K
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.	320	$240	$77.2K
G0378	Hospital observation service, per hour	140	$440	$60.3K
99281	The provider sees a patient for the lowest level emergency department visit.	300	$140	$42.3K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	2,430	$20	$36.5K

Showing 1–10 of 79

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Hca Health Services Of Tennessee, Inc. — 3 of 17 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

79 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	30	630	510	$120	$1.1M
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.	24	610	570	$110	$884.4K
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.	359	570	640	$100	$637.8K
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…	37	100	400	$60	$524.7K
G0378	Hospital observation service, per hour	65	100	410	$210	$264K
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.	148	240	840	$20	$259.2K
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.	23	180	480	$90	$245.5K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	5	120	3,760	$30	$225K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	68	70	250	$20	$215.6K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	69	70	270	$20	$215.5K

Showing 1–10 of 79

Related Providers

Other providers that share a Tax Identification Number (TIN) with Hca Health Services Of Tennessee, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hca Health Services Of Tennessee, Inc.	TN	General Acute Care Hospital	$0	$45.9M
Hca Health Services Of Tennessee, Inc.	TN	General Acute Care Hospital	$0	$27.5M
Hca Health Services Of Tennessee, Inc.	TN	General Acute Care Hospital	$0	$22.1M
Hca Health Services Of Tennessee, Inc.	TN	General Acute Care Hospital	$0	$5.4M

Nearby Providers

Other providers in the same ZIP code as Hca Health Services Of Tennessee, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spark Dental Tn, PLLC	TN	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$33.8M
Spero Health Of Tennessee, LLC	TN	Substance Use Disorder Rehabilitation Clinic/Center	$0	$23.4M
Grace Pediatrics PLLC	TN	Pediatrics Physician	$0	$12M
Feltz Therapy Services, LLC	TN	Rehabilitation Clinic/Center	$0	$11.1M
Children's Dentistry Of Smyrna	TN	Pediatric Dentistry	$0	$8.2M
Nurture Pediatrics, PLLC	TN	Pediatrics Physician	$0	$5M
Cumberland Pediatric Dentistry And Orthodontics Of Murfreesboro, PLLC	TN	Pediatric Dentistry	$0	$4.1M
Smyrna Pediatrics PLLC	TN	Pediatrics Physician	$0	$3.7M
Newberry Emergency Physicians PLLC	TN	Emergency Medicine Physician	$0	$3M
Tennessee Family Solutions, Inc	TN	Developmentally Disabled Services Day Training Agency	$0	$3M

Hca Health Services Of Tennessee, Inc. — Billing Profile & Reimbursement Data

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Hca Health Services Of Tennessee, 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