Clinic
Upstate Family Health Center Incorporated
Upstate Family Health Center Incorporated was paid $13.80M by Medicaid between Jan 2018 and Nov 2024, across 101 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 59% of everything it billed.
33Billing provider infoUPSTATE FAMILY HEALTH CENTER INCORPORATED
UTICA, NY 13502
UTICA, NY 13502
33aNPI1205203023assigned 08/27/2015
33bProvider typeClinic/Center
28Total paid$13.80M
24GClaims190,732
24DCodes billed101
24AFirst – last monthJan 2018 – Nov 2024
Compared with peers
Next to other Clinic/Center providers in New York
Rank by total paid#26 of 235
Median peer was paid$630K
This provider vs. median22×
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.
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 | 12,374 | $1.22M | |
| 2019 | 21,237 | $1.90M | |
| 2020 | 20,774 | $1.52M | |
| 2021 | 28,831 | $2.36M | |
| 2022 | 41,284 | $2.66M | |
| 2023 | 45,022 | $2.56M | |
| 2024incomplete | 21,210 | $1.57M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 59% | 74,745 | 57,788 | $8.18M |
| 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 | 15% | 18,628 | 15,903 | $2.04M |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 7.5% | 12,030 | 6,738 | $1.04M |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 3.7% | 4,778 | 3,150 | $509K |
| 99203 | Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity | 2.6% | 2,923 | 2,435 | $359K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 1.9% | 3,351 | 1,583 | $256K |
| 11721 | 1.9% | 1,558 | 1,504 | $256K | |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 1.4% | 1,212 | 1,177 | $195K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 1.0% | 886 | 819 | $138K |
| G0467 | Community health center visit, returning patientFederally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit | <1% | 8,787 | 4,206 | $138K |
| 99204 | Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | <1% | 1,038 | 958 | $137K |
| 96127 | <1% | 5,670 | 5,375 | $82K |
89 more codes
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 507 | $58K |
| 99395 | Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years | <1% | 286 | $49K |
| 97140 | Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) | <1% | 1,148 | $45K |
| 36415 | Collection of venous blood by venipuncture | <1% | 8,530 | $34K |
| 0001A | <1% | 499 | $28K | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 5,494 | $28K |
| 0012A | <1% | 348 | $26K | |
| 0002A | <1% | 290 | $21K | |
| 0011A | <1% | 454 | $19K | |
| T1013 | Sign language or oral interpretive services, per 15 minutes | <1% | 1,355 | $18K |
| 90832 | Psychotherapy session, about 30 minutes | <1% | 159 | $17K |
| 99396 | Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years | <1% | 88 | $16K |
| 90834 | Psychotherapy session, about 45 minutes | <1% | 103 | $14K |
| 99385 | <1% | 107 | $13K | |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, straightforward | <1% | 70 | $8K |
| 99384 | <1% | 73 | $7K | |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 611 | $6K |
| 0013A | <1% | 136 | $5K | |
| 90688 | <1% | 755 | $4K | |
| 99406 | <1% | 2,353 | $4K | |
| 90791 | Psychiatric diagnostic evaluation | <1% | 27 | $4K |
| 0003A | <1% | 103 | $4K | |
| G2025 | Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only | <1% | 170 | $4K |
| 90837 | Psychotherapy session, about an hour | <1% | 19 | $3K |
| 99441 | <1% | 53 | $3K | |
| 98941 | Chiropractic manipulative treatment; spinal, 3-4 regions | <1% | 548 | $3K |
| 99495 | <1% | 96 | $3K | |
| 99173 | <1% | 732 | $2K | |
| G8417 | Bmi is documented above normal parameters and a follow-up plan is documented | <1% | 3,265 | $2K |
| 98926 | <1% | 279 | $2K | |
| 90674 | <1% | 138 | $2K | |
| 99442 | <1% | 39 | $2K | |
| 90472 | Immunization administration, each additional vaccine (list separately) | <1% | 2,086 | $1K |
| 99383 | <1% | 16 | $1K | |
| 80305 | <1% | 908 | $1K | |
| 99382 | <1% | 15 | $1K | |
| 90670 | <1% | 530 | $1K | |
| 90633 | <1% | 266 | $1K | |
| 0052A | <1% | 21 | $973.85 | |
| 82962 | <1% | 628 | $923.49 | |
| G8420 | Bmi is documented within normal parameters and no follow-up plan is required | <1% | 1,646 | $877.51 |
| 90715 | <1% | 158 | $861.25 | |
| 92250 | <1% | 101 | $780.25 | |
| 0072A | <1% | 16 | $773.85 | |
| 87637 | Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV | <1% | 188 | $702.48 |
| 90651 | <1% | 99 | $519.51 | |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | <1% | 4,679 | $430.43 |
| 81002 | <1% | 372 | $362.82 | |
| G8431 | Screening for depression is documented as being positive and a follow-up plan is documented | <1% | 806 | $355.35 |
| G8482 | Influenza immunization administered or previously received | <1% | 918 | $246.70 |
| G8484 | Influenza immunization was not administered, reason not given | <1% | 1,020 | $246.70 |
| Q0091 | Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory | <1% | 235 | $237.89 |
| 69210 | <1% | 21 | $217.32 | |
| G9903 | Patient screened for tobacco use and identified as a tobacco non-user | <1% | 985 | $182.01 |
| 90656 | <1% | 667 | $175.01 | |
| 81025 | <1% | 74 | $174.27 | |
| G0447 | Face-to-face behavioral counseling for obesity, 15 minutes | <1% | 119 | $172.25 |
| G8427 | Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications | <1% | 3,528 | $69.23 |
| 93000 | <1% | 141 | $58.11 | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 315 | $55.70 |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 101 | $11.25 |
| G8418 | Bmi is documented below normal parameters and a follow-up plan is documented | 0% | 258 | $0.00 |
| G9902 | Patient screened for tobacco use and identified as a tobacco user | 0% | 1,148 | $0.00 |
| J1885 | Injection, ketorolac tromethamine, per 15 mg | 0% | 43 | $0.00 |
| G9906 | Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) | 0% | 741 | $0.00 |
| G8754 | Most recent diastolic blood pressure < 90 mmhg | 0% | 742 | $0.00 |
| 90697 | 0% | 70 | $0.00 | |
| G8432 | Depression screening not documented, reason not given | 0% | 35 | $0.00 |
| 90686 | 0% | 251 | $0.00 | |
| 90733 | 0% | 13 | $0.00 | |
| 91301 | 0% | 34 | $0.00 | |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 0% | 29 | $0.00 |
| 87807 | 0% | 44 | $0.00 | |
| 90698 | 0% | 24 | $0.00 | |
| 91305 | 0% | 21 | $0.00 | |
| G9716 | Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason | 0% | 12 | $0.00 |
| G8755 | Most recent diastolic blood pressure >= 90 mmhg | 0% | 19 | $0.00 |
| G0030 | Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user | 0% | 341 | $0.00 |
| G9905 | Patient not screened for tobacco use | 0% | 61 | $0.00 |
| G9899 | Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed | 0% | 169 | $0.00 |
| 90734 | 0% | 86 | $0.00 | |
| G8752 | Most recent systolic blood pressure < 140 mmhg | 0% | 686 | $0.00 |
| 91300 | 0% | 112 | $0.00 | |
| G8483 | Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) | 0% | 466 | $0.00 |
| 94664 | 0% | 45 | $0.00 | |
| 90710 | 0% | 71 | $0.00 | |
| G8753 | Most recent systolic blood pressure >= 140 mmhg | 0% | 68 | $0.00 |
| G9900 | Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified | 0% | 31 | $0.00 |
| 97803 | 0% | 12 | $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 officialSCHMIDT, WANDA (OPERATIONS MANAGER)