Hospital
Avera ST Marys
Avera ST Marys was paid $4.57M by Medicaid between Jan 2018 and Dec 2024, across 141 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 25% of everything it billed.
33Billing provider infoAVERA ST MARYS
PIERRE, SD 57501
PIERRE, SD 57501
33aNPI1720326713assigned 01/25/2013
33bProvider typeGeneral Acute Care Hospital
28Total paid$4.57M
24GClaims147,738
24DCodes billed141
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other General Acute Care Hospital providers in South Dakota
Rank by total paid#3 of 17
Median peer was paid$547K
This provider vs. median8.4×
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 | 19,307 | $560K | |
| 2019 | 19,707 | $585K | |
| 2020 | 9,747 | $296K | |
| 2021 | 19,311 | $621K | |
| 2022 | 23,922 | $713K | |
| 2023 | 28,197 | $793K | |
| 2024incomplete | 27,547 | $1.00M |
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 | 25% | 32,293 | 25,518 | $1.16M |
| 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 | 16% | 13,550 | 11,300 | $726K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 5.1% | 3,854 | 3,160 | $233K |
| 99203 | Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity | 4.3% | 3,629 | 3,009 | $196K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 3.8% | 5,095 | 4,763 | $174K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 3.6% | 2,662 | 2,487 | $163K |
| 0241U | Neonatal screening for hereditary disorders, genomic sequence analysis panel | 2.6% | 1,047 | 971 | $119K |
| 74177 | Computed tomography, abdomen and pelvis; with contrast material | 2.2% | 1,451 | 1,322 | $102K |
| W0037 | 2.1% | 6,553 | 6,553 | $97K | |
| 99238 | Hospital discharge day management, 30 minutes or less | 2.0% | 1,930 | 1,702 | $93K |
| 99215 | Doctor's office visit, returning patient (complex)Prolong outpt/office vis | 2.0% | 1,300 | 1,096 | $92K |
| 76816 | Ultrasound, pregnant uterus, real time with image documentation, follow-up | 1.9% | 2,211 | 1,831 | $88K |
129 more codes
| 99204 | Doctor's office visit, new patient (more involved) | 1.8% | 971 | $81K |
| 99232 | Hospital visit by a doctor, follow-up day | 1.6% | 2,374 | $73K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 1.6% | 1,116 | $72K |
| 99460 | 1.3% | 794 | $60K | |
| 99239 | Hospital discharge day management, more than 30 minutes | 1.3% | 1,081 | $59K |
| 99308 | Subsequent nursing facility care, per day, straightforward | 1.2% | 2,330 | $55K |
| 87651 | Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe | 1.2% | 1,871 | $53K |
| 99223 | Prolong inpt eval add15 m | 1.1% | 604 | $50K |
| 76811 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed | 1.0% | 433 | $46K |
| 70450 | Computed tomography, head or brain; without contrast material | <1% | 1,112 | $42K |
| 76801 | <1% | 750 | $42K | |
| 99222 | Initial hospital care, per day, moderate complexity | <1% | 609 | $41K |
| 71046 | Radiologic examination, chest; 2 views | <1% | 3,974 | $40K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 1,865 | $38K |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, straightforward | <1% | 907 | $32K |
| 73630 | <1% | 2,799 | $31K | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 3,077 | $30K |
| 0240U | <1% | 267 | $29K | |
| 76819 | Fetal biophysical profile; without non-stress testing | <1% | 674 | $26K |
| 59409 | Vaginal delivery only (with or without episiotomy and/or forceps) | <1% | 45 | $26K |
| 36415 | Collection of venous blood by venipuncture | <1% | 4,771 | $24K |
| 59025 | Fetal non-stress test | <1% | 1,225 | $24K |
| 90472 | Immunization administration, each additional vaccine (list separately) | <1% | 1,085 | $21K |
| 71045 | Radiologic examination, chest; single view | <1% | 3,113 | $18K |
| 99309 | Subsequent nursing facility care, per day, low to moderate complexity | <1% | 441 | $16K |
| 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% | 247 | $16K |
| 59400 | Routine obstetric care including antepartum care, vaginal delivery, and postpartum care | <1% | 17 | $16K |
| 99233 | Hospital visit by a doctor, follow-up day (complex) | <1% | 303 | $16K |
| 90715 | <1% | 927 | $16K | |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 1,583 | $14K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 199 | $13K |
| Q3014 | Telehealth originating site facility fee | <1% | 629 | $13K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | <1% | 2,243 | $13K |
| 99188 | <1% | 509 | $11K | |
| 73610 | <1% | 988 | $11K | |
| 74018 | <1% | 993 | $10K | |
| 80053 | Comprehensive metabolic panel | <1% | 1,250 | $10K |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | <1% | 283 | $9K |
| 76805 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation | <1% | 159 | $9K |
| 90686 | <1% | 2,799 | $8K | |
| 80061 | Lipid panel | <1% | 620 | $7K |
| 20610 | <1% | 199 | $6K | |
| 80050 | General health panel | <1% | 238 | $6K |
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 717 | $6K |
| 84443 | Thyroid stimulating hormone (TSH) | <1% | 357 | $5K |
| 69436 | Tympanostomy (requiring insertion of ventilating tube), general anesthesia | <1% | 15 | $4K |
| 90677 | <1% | 404 | $4K | |
| 73562 | <1% | 397 | $4K | |
| 76376 | <1% | 369 | $4K | |
| 0002A | <1% | 86 | $3K | |
| 71275 | Computed tomographic angiography, chest, with contrast material | <1% | 30 | $3K |
| 74176 | Computed tomography, abdomen and pelvis; without contrast material | <1% | 56 | $3K |
| 73030 | <1% | 264 | $3K | |
| 0071A | <1% | 77 | $3K | |
| 90670 | <1% | 1,959 | $3K | |
| 0001A | <1% | 67 | $2K | |
| 73110 | <1% | 205 | $2K | |
| 0072A | <1% | 70 | $2K | |
| 81001 | <1% | 930 | $2K | |
| 99231 | Subsequent hospital care, per day, straightforward or low complexity | <1% | 92 | $2K |
| 54150 | <1% | 14 | $2K | |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | <1% | 78 | $2K |
| 90473 | <1% | 160 | $2K | |
| 90480 | <1% | 65 | $2K | |
| 90656 | <1% | 295 | $1K | |
| 99396 | Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years | <1% | 13 | $1K |
| 91322 | <1% | 12 | $1K | |
| 84439 | <1% | 213 | $1K | |
| 86140 | <1% | 327 | $1K | |
| 80048 | Basic metabolic panel (calcium, ionized) | <1% | 213 | $1K |
| 11721 | <1% | 117 | $1K | |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | <1% | 26 | $1K |
| 90651 | <1% | 334 | $1K | |
| 81025 | <1% | 179 | $1K | |
| 99395 | Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years | <1% | 12 | $1K |
| 72125 | Computed tomography, cervical spine; without contrast material | <1% | 24 | $1K |
| 76830 | Ultrasound, transvaginal | <1% | 25 | $948.70 |
| 99306 | Prolong nursin fac eval 15m | <1% | 13 | $874.78 |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 92 | $859.40 |
| 76817 | Ultrasound, pregnant uterus, real time with image documentation, transvaginal | <1% | 16 | $825.44 |
| 73130 | <1% | 62 | $746.61 | |
| 82728 | <1% | 60 | $722.39 | |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 149 | $718.85 |
| 73502 | <1% | 60 | $670.86 | |
| 96161 | <1% | 95 | $591.08 | |
| 99462 | <1% | 16 | $573.60 | |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | <1% | 183 | $566.83 |
| 93010 | Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only | <1% | 101 | $518.79 |
| 90671 | <1% | 276 | $492.40 | |
| 99307 | <1% | 14 | $445.08 | |
| 99217 | <1% | 14 | $438.79 | |
| 36416 | <1% | 604 | $365.35 | |
| 90633 | <1% | 1,486 | $353.23 | |
| 83550 | <1% | 45 | $349.60 | |
| G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) | <1% | 192 | $344.50 |
| 82570 | <1% | 79 | $341.88 | |
| 74019 | <1% | 35 | $327.48 | |
| 76705 | Ultrasound, abdominal, real time with image documentation; limited | <1% | 13 | $319.88 |
| 96381 | <1% | 18 | $287.38 | |
| 83540 | <1% | 49 | $271.74 | |
| 72100 | <1% | 16 | $233.31 | |
| 73140 | <1% | 27 | $187.53 | |
| 93005 | Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | <1% | 29 | $140.03 |
| 90688 | <1% | 16 | $111.29 | |
| 94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction | <1% | 17 | $85.04 |
| 85027 | <1% | 15 | $71.17 | |
| 82950 | <1% | 12 | $52.25 | |
| 96127 | <1% | 15 | $50.78 | |
| 85018 | <1% | 26 | $50.47 | |
| 90685 | <1% | 79 | $44.91 | |
| J0665 | Injection, bupivicaine, not otherwise specified, 0.5 mg | <1% | 67 | $1.29 |
| 90648 | 0% | 2,183 | $0.00 | |
| 90700 | 0% | 65 | $0.00 | |
| 90461 | 0% | 739 | $0.00 | |
| 90734 | 0% | 258 | $0.00 | |
| 90707 | 0% | 112 | $0.00 | |
| 90681 | 0% | 84 | $0.00 | |
| 90710 | 0% | 182 | $0.00 | |
| 91300 | 0% | 23 | $0.00 | |
| 90696 | 0% | 166 | $0.00 | |
| 90723 | 0% | 1,665 | $0.00 | |
| 90697 | 0% | 202 | $0.00 | |
| 90680 | 0% | 1,542 | $0.00 | |
| 90716 | 0% | 104 | $0.00 | |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 0% | 26 | $0.00 |
| 91307 | 0% | 70 | $0.00 | |
| 90381 | 0% | 13 | $0.00 | |
| 99024 | 0% | 31 | $0.00 | |
| 91305 | 0% | 31 | $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 officialKREBS, SHANTEL (CEO)
Parent organizationAVERA ST MARYS
| Provider | Location | Paid |
|---|---|---|
| Avera Gettysburg | Gettysburg, SD | $5K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.