Hospital
Prisma Health-Upstate
Prisma Health-Upstate was paid $21.98M by Medicaid between Jan 2018 and Dec 2024, across 102 billing codes. Its largest line is 36415, Collection of venous blood by venipuncture — 37% of everything it billed.
33Billing provider infoPRISMA HEALTH-UPSTATE
GREENVILLE, SC 29605
GREENVILLE, SC 29605
33aNPI1407301211assigned 08/22/2016
33bProvider typeGeneral Acute Care Hospital
28Total paid$21.98M
24GClaims567,615
24DCodes billed102
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other General Acute Care Hospital providers in South Carolina
Rank by total paid#17 of 115
Median peer was paid$2.47M
This provider vs. median8.9×
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 | 91,710 | $3.57M | |
| 2019 | 95,734 | $3.61M | |
| 2020 | 89,041 | $3.47M | |
| 2021 | 91,391 | $3.48M | |
| 2022 | 73,997 | $3.06M | |
| 2023 | 70,216 | $2.82M | |
| 2024incomplete | 55,526 | $1.98M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 36415 | Collection of venous blood by venipuncture | 37% | 43,809 | 36,776 | $8.24M |
| 81025 | 12% | 7,764 | 7,425 | $2.58M | |
| 81003 | 11% | 64,024 | 40,151 | $2.36M | |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 9.2% | 59,804 | 46,679 | $2.01M |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | 7.0% | 18,761 | 18,134 | $1.53M |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | 4.6% | 9,506 | 8,791 | $1.02M |
| 87210 | 2.8% | 5,940 | 5,010 | $611K | |
| 87086 | Culture, bacterial; quantitative colony count, urine | 2.5% | 17,996 | 16,412 | $552K |
| 87624 | Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types | 2.2% | 5,052 | 4,898 | $479K |
| 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 | 2.2% | 43,533 | 30,936 | $478K |
| 82962 | 1.5% | 7,033 | 4,400 | $326K | |
| 88305 | Level IV - Surgical pathology, gross and microscopic examination | 1.4% | 1,608 | 1,573 | $309K |
90 more codes
| 87077 | <1% | 4,560 | $204K | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 6,152 | $162K |
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | <1% | 1,890 | $155K |
| 82570 | <1% | 5,274 | $145K | |
| 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% | 9,537 | $135K |
| 59025 | Fetal non-stress test | <1% | 7,482 | $134K |
| 87081 | <1% | 6,193 | $100K | |
| 58301 | <1% | 563 | $99K | |
| 11982 | <1% | 273 | $95K | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 978 | $60K |
| 58300 | <1% | 562 | $43K | |
| 87661 | Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe | <1% | 17,711 | $37K |
| 99395 | Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years | <1% | 2,500 | $26K |
| 86850 | <1% | 9,245 | $12K | |
| 80053 | Comprehensive metabolic panel | <1% | 7,324 | $8K |
| 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% | 57 | $6K |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | <1% | 18,411 | $5K |
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 4,556 | $5K |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 8,015 | $5K |
| 82950 | <1% | 9,151 | $4K | |
| 90715 | <1% | 5,671 | $4K | |
| 99396 | Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years | <1% | 116 | $4K |
| 83986 | <1% | 36 | $3K | |
| 0012A | <1% | 243 | $3K | |
| 84156 | <1% | 5,460 | $3K | |
| Q3014 | Telehealth originating site facility fee | <1% | 113 | $2K |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | <1% | 45 | $2K |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | <1% | 7,253 | $2K |
| J7307 | Etonogestrel (contraceptive) implant system, including implant and supplies | <1% | 166 | $2K |
| 87801 | Infectious agent detection by nucleic acid; amplified probe, multiple organisms | <1% | 137 | $2K |
| 85027 | <1% | 16,835 | $2K | |
| 84702 | <1% | 1,495 | $1K | |
| 87529 | <1% | 12 | $1K | |
| 90686 | <1% | 3,536 | $1K | |
| 86780 | <1% | 15,825 | $1K | |
| 0011A | <1% | 296 | $1K | |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | <1% | 16,359 | $1K |
| 90678 | <1% | 201 | $1K | |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 214 | $1K |
| 84443 | Thyroid stimulating hormone (TSH) | <1% | 3,264 | $959.15 |
| 90651 | <1% | 398 | $855.56 | |
| 99215 | Doctor's office visit, returning patient (complex) | <1% | 1,085 | $739.29 |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | <1% | 3,284 | $723.83 |
| 86900 | <1% | 8,136 | $545.28 | |
| 83020 | <1% | 4,603 | $490.20 | |
| 86803 | <1% | 9,281 | $462.80 | |
| 82947 | <1% | 831 | $397.28 | |
| 86901 | <1% | 8,122 | $344.15 | |
| 85018 | <1% | 131 | $316.80 | |
| 86592 | <1% | 2,880 | $287.82 | |
| H0002 | Behavioral health screening to determine eligibility for admission to treatment program | <1% | 5,671 | $175.09 |
| 82951 | <1% | 719 | $93.21 | |
| 0064A | <1% | 51 | $34.09 | |
| G0472 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) | 0% | 442 | $0.00 |
| 83615 | 0% | 1,408 | $0.00 | |
| 57454 | 0% | 130 | $0.00 | |
| 86762 | 0% | 7,711 | $0.00 | |
| 87340 | 0% | 8,134 | $0.00 | |
| 82728 | 0% | 225 | $0.00 | |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 0% | 8,324 | $0.00 |
| 86870 | 0% | 83 | $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% | 55 | $0.00 |
| J2791 | Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu | 0% | 226 | $0.00 |
| 86317 | 0% | 254 | $0.00 | |
| 90656 | 0% | 215 | $0.00 | |
| 86704 | 0% | 254 | $0.00 | |
| J7298 | Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg | 0% | 63 | $0.00 |
| 88141 | 0% | 16 | $0.00 | |
| 82105 | 0% | 257 | $0.00 | |
| 82952 | 0% | 247 | $0.00 | |
| 87522 | Neg quan hep c or qual rna | 0% | 67 | $0.00 |
| J2790 | Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) | 0% | 13 | $0.00 |
| J0696 | Injection, ceftriaxone sodium, per 250 mg | 0% | 42 | $0.00 |
| 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 | 0% | 30 | $0.00 |
| 87536 | 0% | 17 | $0.00 | |
| G0123 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision | 0% | 16 | $0.00 |
| 86787 | 0% | 6,409 | $0.00 | |
| 87798 | Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism | 0% | 42 | $0.00 |
| 84550 | 0% | 1,593 | $0.00 | |
| 83540 | 0% | 188 | $0.00 | |
| 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 | 0% | 58 | $0.00 |
| 87186 | 0% | 2,250 | $0.00 | |
| 84466 | 0% | 201 | $0.00 | |
| 85007 | 0% | 197 | $0.00 | |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 0% | 143 | $0.00 |
| 90472 | Immunization administration, each additional vaccine (list separately) | 0% | 340 | $0.00 |
| 84146 | 0% | 118 | $0.00 | |
| J7297 | Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg | 0% | 84 | $0.00 |
| 99204 | Doctor's office visit, new patient (more involved) | 0% | 18 | $0.00 |
| 11981 | 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 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 | $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-Upstate | Greenville, SC | $4.65M |
| 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.