Hospital
Prisma Health-Upstate
Prisma Health-Upstate was paid $4.65M by Medicaid between Jan 2018 and Dec 2024, across 93 billing codes. Its largest line is 99212, Office or other outpatient visit for the evaluation and management of an established patient, straightforward — 26% of everything it billed.
33Billing provider infoPRISMA HEALTH-UPSTATE
GREENVILLE, SC 29605
GREENVILLE, SC 29605
33aNPI1174079271assigned 08/29/2016
33bProvider typeGeneral Acute Care Hospital
28Total paid$4.65M
24GClaims95,331
24DCodes billed93
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other General Acute Care Hospital providers in South Carolina
Rank by total paid#52 of 115
Median peer was paid$2.47M
This provider vs. median1.9×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Entity ProliferationAuthorized official MILLER, POLLY controls 20+ related entities in our dataset. Read more
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 10,309 | $591K | |
| 2019 | 13,515 | $693K | |
| 2020 | 9,281 | $556K | |
| 2021 | 14,594 | $710K | |
| 2022 | 14,986 | $692K | |
| 2023 | 16,413 | $724K | |
| 2024incomplete | 16,233 | $686K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 26% | 17,522 | 16,052 | $1.20M |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 25% | 18,436 | 16,499 | $1.18M |
| 36415 | Collection of venous blood by venipuncture | 24% | 7,120 | 6,626 | $1.10M |
| 81025 | 4.4% | 1,688 | 1,629 | $203K | |
| 83036 | Hemoglobin; glycosylated (A1C) | 3.9% | 3,933 | 3,773 | $180K |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | 2.6% | 1,861 | 1,801 | $120K |
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 2.4% | 2,049 | 1,855 | $114K |
| 81003 | 2.2% | 2,799 | 2,300 | $102K | |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 2.1% | 907 | 859 | $99K |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | 1.0% | 651 | 593 | $48K |
| 87210 | 1.0% | 487 | 413 | $48K | |
| 82043 | 1.0% | 681 | 653 | $47K |
81 more codes
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | <1% | 429 | $41K |
| C9803 | Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | <1% | 161 | $25K |
| 87086 | Culture, bacterial; quantitative colony count, urine | <1% | 503 | $23K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | <1% | 128 | $14K |
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | <1% | 124 | $12K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 104 | $11K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 96 | $10K |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | <1% | 172 | $9K |
| 0002A | <1% | 242 | $7K | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 146 | $6K |
| 36416 | <1% | 236 | $6K | |
| 90686 | <1% | 2,097 | $5K | |
| 81001 | <1% | 705 | $5K | |
| 0001A | <1% | 287 | $5K | |
| G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision | <1% | 177 | $4K |
| 83655 | <1% | 142 | $4K | |
| 87661 | Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe | <1% | 1,008 | $3K |
| 90656 | <1% | 321 | $3K | |
| 90670 | <1% | 1,007 | $3K | |
| 82570 | <1% | 714 | $2K | |
| 80053 | Comprehensive metabolic panel | <1% | 1,768 | $2K |
| 87636 | Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B | <1% | 12 | $1K |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, straightforward | <1% | 30 | $1K |
| 85610 | <1% | 24 | $1K | |
| 0004A | <1% | 120 | $1K | |
| 90715 | <1% | 930 | $1K | |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 35 | $1K |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | <1% | 43 | $1K |
| 80048 | Basic metabolic panel (calcium, ionized) | <1% | 1,558 | $1K |
| U0005 | 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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 | <1% | 42 | $840.45 |
| 90633 | <1% | 422 | $753.71 | |
| 80061 | Lipid panel | <1% | 2,049 | $717.38 |
| 84443 | Thyroid stimulating hormone (TSH) | <1% | 1,368 | $629.24 |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 157 | $625.26 |
| 92250 | <1% | 52 | $591.51 | |
| 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 throughput technologies as described by cms-2020-01-r | <1% | 138 | $580.27 |
| 90651 | <1% | 528 | $577.29 | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 2,673 | $412.18 |
| 90716 | <1% | 98 | $300.14 | |
| 91320 | <1% | 186 | $293.06 | |
| Q3014 | Telehealth originating site facility fee | <1% | 45 | $287.44 |
| 0054A | <1% | 121 | $277.13 | |
| 90682 | <1% | 599 | $267.03 | |
| 85027 | <1% | 1,245 | $255.45 | |
| 90480 | <1% | 254 | $232.36 | |
| 90713 | <1% | 58 | $176.49 | |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | <1% | 3,908 | $165.98 |
| 90739 | <1% | 389 | $136.61 | |
| 87207 | <1% | 85 | $126.73 | |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | <1% | 1,056 | $123.41 |
| 92228 | <1% | 13 | $119.82 | |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | <1% | 874 | $117.65 |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | <1% | 1,777 | $95.91 |
| 90677 | <1% | 492 | $93.01 | |
| 90698 | <1% | 416 | $80.00 | |
| 0124A | <1% | 167 | $69.03 | |
| 90619 | <1% | 82 | $68.44 | |
| 90647 | <1% | 33 | $34.27 | |
| 90734 | <1% | 50 | $20.17 | |
| 90744 | <1% | 301 | $20.17 | |
| 87899 | 0% | 72 | $0.00 | |
| 90461 | 0% | 865 | $0.00 | |
| 90685 | 0% | 29 | $0.00 | |
| 86480 | 0% | 258 | $0.00 | |
| 90472 | Immunization administration, each additional vaccine (list separately) | 0% | 480 | $0.00 |
| 90681 | 0% | 83 | $0.00 | |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | 0% | 193 | $0.00 |
| 90662 | 0% | 12 | $0.00 | |
| 90710 | 0% | 16 | $0.00 | |
| 93005 | Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | 0% | 15 | $0.00 |
| 86780 | 0% | 582 | $0.00 | |
| G0008 | Administration of influenza virus vaccine | 0% | 171 | $0.00 |
| 87340 | 0% | 403 | $0.00 | |
| 90697 | 0% | 156 | $0.00 | |
| 86803 | 0% | 529 | $0.00 | |
| G0472 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) | 0% | 121 | $0.00 |
| 90732 | 0% | 78 | $0.00 | |
| 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 not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed | 0% | 29 | $0.00 |
| 90680 | 0% | 45 | $0.00 | |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 0% | 12 | $0.00 |
| 90723 | 0% | 51 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialMILLER, POLLY (VP PAYOR STRATEGIES & ALIGNMENT)
| Provider | Location | Paid |
|---|---|---|
| Prisma Health-Midlands | Columbia, SC | $74.58M |
| Prisma Health-Midlands | Columbia, SC | $68.26M |
| Prisma Health-Upstate | Greenville, SC | $25.04M |
| Prisma Health-Upstate | Greenville, SC | $21.98M |
| Prisma Health-Upstate | Greenville, SC | $19.69M |
| Prisma Health-Upstate | Seneca, SC | $15.64M |
| Prisma Health-Midlands | Columbia, SC | $11.77M |
| Prisma Health-Upstate | Greenville, SC | $10.74M |
| Greenville Health Corporation | Greenville, SC | $8.90M |
| Prisma Health-Upstate | Greenville, SC | $8.32M |
| Prisma Health-Upstate | Greenville, SC | $7.45M |
| Prisma Health University Medical Group | Greenville, SC | $7.44M |
| Prisma Health-Midlands | Coulmbia, SC | $7.43M |
| Prisma Health-Midlands | Columbia, SC | $6.88M |
| Prisma Health Tuomey | Sumter, SC | $6.84M |
| Prisma Health-Midlands | Columbia, SC | $6.77M |
| Prisma Health-Upstate | Greenville, SC | $6.37M |
| Prisma Health-Upstate | Greenville, SC | $5.00M |
| Prisma Health-Midlands | Columbia, SC | $4.63M |
| Prisma Health-Upstate | Seneca, SC | $4.48M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.