Medicaid Provider SpendingClaims paid 2018–2024 · HHS public file
Home › VA › Roanoke › NPI 1730123472
Clinic

Carilion Medical Center

Carilion Medical Center was paid $73.43M by Medicaid between Jan 2018 and Dec 2024, across 357 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 20% of everything it billed.

33Billing provider infoCARILION MEDICAL CENTER
ROANOKE, VA 24014
33aNPI1730123472assigned 06/15/2006
33bProvider typeMulti-Specialty Clinic/Center
28Total paid$73.43M
24GClaims1,703,973
24DCodes billed357
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers

Next to other Multi-Specialty Clinic/Center providers in Virginia

Rank by total paid#2 of 27
Median peer was paid$349K
This provider vs. median211×

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 PRESCOTT, ELEANOR controls 20+ related entities in our dataset. Read more
Box 24A · Dates of service

Paid by month

$0$500K$1.0M$1.5M2018201920202021202220232024
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
YearClaimsPaid
2018114,120$2.89M
2019277,997$10.73M
2020228,099$10.45M
2021255,166$11.48M
2022284,188$12.49M
2023293,793$13.41M
2024incomplete250,610$11.99M
Box 24 · Service lines

What it billed for

CodeServiceShareClaimsBene. recordsPaid
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 20% 201,457 186,958 $14.93M
99213 Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity 14% 194,582 179,005 $10.30M
99232 Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity 5.7% 103,690 39,865 $4.15M
99233 Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m 5.4% 73,748 29,549 $3.95M
G9012 Other specified case management service not elsewhere classified 4.3% 12,899 12,410 $3.15M
99215 Doctor's office visit, returning patient (complex)Prolong outpt/office vis 3.6% 22,153 21,199 $2.61M
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 3.0% 19,645 18,786 $2.22M
99223 Prolong inpt eval add15 m 2.8% 21,030 19,526 $2.06M
J0585 Injection, onabotulinumtoxina, 1 unit 2.2% 2,548 1,543 $1.61M
99203 Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity 1.9% 19,041 18,111 $1.37M
99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) 1.8% 16,307 15,949 $1.35M
93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete 1.8% 24,068 22,772 $1.32M
345 more codes
76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up 1.7% 15,101 $1.22M
90833 Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) 1.6% 18,989 $1.21M
99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes 1.5% 11,095 $1.10M
99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) 1.5% 14,550 $1.08M
76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed 1.2% 5,914 $848K
99239 Hospital discharge day management, more than 30 minutes 1.1% 14,592 $825K
74177 Computed tomography, abdomen and pelvis; with contrast material 1.0% 11,426 $735K
93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only <1% 146,782 $733K
99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) <1% 8,346 $691K
59400 Routine obstetric care including antepartum care, vaginal delivery, and postpartum care <1% 303 $664K
99222 Initial hospital care, per day, moderate complexity <1% 7,981 $615K
99205 Prolong outpt/office vis <1% 3,692 $568K
90834 Psychotherapy session, about 45 minutes <1% 8,594 $557K
H0005 Alcohol and/or drug services; group counseling by a clinician <1% 16,874 $525K
71045 Radiologic examination, chest; single view <1% 98,405 $525K
99285 Emergency room visit (most serious) <1% 4,203 $447K
70450 Computed tomography, head or brain; without contrast material <1% 14,021 $376K
70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences <1% 4,695 $360K
77067 Screening mammography, bilateral, including computer-aided detection <1% 11,116 $326K
90686 <1% 23,921 $324K
95819 <1% 2,063 $322K
76819 Fetal biophysical profile; without non-stress testing <1% 4,146 $280K
71275 Computed tomographic angiography, chest, with contrast material <1% 4,151 $266K
99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) <1% 2,907 $263K
99188 <1% 12,334 $261K
90792 Psychiatric diagnostic evaluation with medical services <1% 1,580 $246K
90791 Psychiatric diagnostic evaluation <1% 1,878 $230K
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward <1% 6,741 $202K
76705 Ultrasound, abdominal, real time with image documentation; limited <1% 8,828 $187K
90670 <1% 10,807 $162K
59025 Fetal non-stress test <1% 4,315 $161K
64615 <1% 1,468 $159K
96112 <1% 1,287 $158K
90853 Group psychotherapy (other than of a multiple-family group) <1% 7,986 $155K
94010 <1% 5,578 $150K
72148 Magnetic resonance imaging, lumbar spine; without contrast material <1% 2,751 $145K
99417 Prolong home eval add 15m <1% 3,431 $143K
74018 <1% 23,670 $141K
74176 Computed tomography, abdomen and pelvis; without contrast material <1% 2,179 $132K
76825 <1% 605 $130K
76830 Ultrasound, transvaginal <1% 4,200 $130K
92551 <1% 12,360 $129K
99231 Subsequent hospital care, per day, straightforward or low complexity <1% 5,366 $128K
96110 Developmental screening, with scoring and documentation, per standardized instrument <1% 12,593 $127K
71046 Radiologic examination, chest; 2 views <1% 16,974 $125K
95886 <1% 1,292 $122K
95816 <1% 844 $117K
0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel <1% 857 $109K
H0004 Behavioral health counseling and therapy, per 15 minutes <1% 1,550 $109K
90680 <1% 7,751 $106K
93970 <1% 5,478 $104K
90723 <1% 7,454 $103K
90837 Psychotherapy session, about an hour <1% 1,026 $100K
99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward <1% 2,027 $99K
90647 <1% 7,372 $92K
20611 <1% 1,374 $88K
93000 <1% 7,194 $86K
72125 Computed tomography, cervical spine; without contrast material <1% 2,345 $84K
72141 <1% 1,589 $83K
20610 <1% 2,084 $83K
93971 <1% 6,338 $82K
96127 <1% 13,956 $79K
71260 Computed tomography, thorax, diagnostic; with contrast material <1% 1,878 $78K
76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation <1% 1,741 $77K
70551 Magnetic resonance imaging, brain; without contrast material <1% 1,607 $76K
99238 Hospital discharge day management, 30 minutes or less <1% 1,477 $74K
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% 8,599 $73K
70498 <1% 1,116 $70K
90633 <1% 4,951 $69K
96130 <1% 704 $67K
90836 <1% 787 $67K
78815 Positron emission tomography (PET) for limited area imaging <1% 1,108 $66K
69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia <1% 346 $64K
95810 Polysomnography; sleep staging with 4 or more additional parameters <1% 833 $63K
93325 <1% 4,763 $62K
92567 <1% 4,728 $61K
36415 Collection of venous blood by venipuncture <1% 30,335 $60K
71250 <1% 1,614 $60K
99221 <1% 1,279 $60K
95251 <1% 1,992 $59K
83036 Hemoglobin; glycosylated (A1C) <1% 7,052 $58K
J1050 Injection, medroxyprogesterone acetate, 1 mg <1% 697 $58K
77063 Screening digital breast tomosynthesis, bilateral <1% 2,258 $57K
11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm <1% 1,586 $57K
70496 <1% 894 $56K
76820 <1% 1,480 $56K
96040 <1% 2,408 $55K
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple <1% 644 $54K
72110 <1% 3,240 $52K
95951 <1% 354 $52K
11721 <1% 3,955 $52K
76642 <1% 1,931 $51K
90651 <1% 2,541 $50K
99309 Subsequent nursing facility care, per day, low to moderate complexity <1% 4,958 $49K
92579 <1% 1,228 $47K
98929 <1% 734 $46K
90832 Psychotherapy session, about 30 minutes <1% 821 $45K
99442 <1% 1,097 $44K
99284 Emergency room visit (serious) <1% 594 $44K
73721 Magnetic resonance imaging, any joint of lower extremity; without contrast material <1% 840 $43K
90677 <1% 2,053 $43K
92557 <1% 1,503 $41K
96137 <1% 598 $40K
72132 <1% 856 $39K
99381 <1% 613 $39K
76770 <1% 1,435 $39K
96131 <1% 443 $39K
72170 <1% 3,447 $39K
74183 <1% 479 $38K
72082 <1% 1,239 $38K
73630 <1% 5,052 $37K
99283 Emergency room visit (moderate) <1% 1,079 $36K
73030 <1% 4,422 $35K
95720 <1% 258 $34K
93880 <1% 1,721 $34K
95806 <1% 980 $34K
90656 <1% 1,810 $33K
77066 Tomosynthesis, mammo <1% 773 $33K
90847 Family psychotherapy with the patient present, 50 minutes <1% 298 $30K
74174 <1% 394 $30K
99220 <1% 319 $30K
31231 <1% 188 $30K
81025 <1% 4,142 $29K
76801 <1% 392 $29K
73562 <1% 3,321 $28K
72129 <1% 616 $28K
73564 <1% 2,753 $28K
99173 <1% 10,878 $28K
99395 Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years <1% 317 $27K
77065 Tomosynthesis, mammo <1% 815 $27K
76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal <1% 829 $27K
85018 <1% 10,525 $26K
92558 <1% 1,298 $25K
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular <1% 1,911 $24K
94060 <1% 1,151 $24K
73502 <1% 2,724 $24K
72100 <1% 2,578 $24K
96136 <1% 650 $23K
76536 <1% 1,046 $23K
59510 <1% 12 $23K
96161 <1% 8,959 $23K
90697 <1% 1,361 $22K
73130 <1% 3,007 $22K
64493 <1% 255 $21K
93308 <1% 676 $21K
90734 <1% 1,185 $21K
73610 <1% 2,876 $21K
99443 <1% 396 $20K
93295 <1% 1,023 $20K
87804 Infectious agent antigen detection by immunoassay; Influenza, each type <1% 1,356 $19K
77077 <1% 926 $18K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine <1% 3,012 $18K
99219 <1% 180 $18K
76813 <1% 205 $18K
99384 <1% 170 $17K
99152 <1% 2,002 $17K
93321 <1% 1,222 $16K
93303 Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study <1% 103 $15K
72158 <1% 182 $15K
95811 <1% 219 $14K
77062 <1% 234 $14K
93297 <1% 1,135 $14K
88738 <1% 3,418 $14K
72131 <1% 391 $14K
71271 <1% 384 $13K
90710 <1% 902 $13K
96111 <1% 130 $13K
43775 <1% 13 $12K
93294 <1% 1,010 $12K
95913 <1% 67 $12K
72040 <1% 1,330 $12K
62323 <1% 159 $11K
99308 Subsequent nursing facility care, per day, straightforward <1% 1,154 $11K
76815 Ultrasound, pregnant uterus, real time with image documentation, limited <1% 207 $11K
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A <1% 767 $11K
72050 <1% 960 $11K
99441 <1% 413 $11K
90707 <1% 727 $11K
95004 Percutaneous tests with allergenic extracts, immediate type reaction <1% 211 $10K
90716 <1% 692 $10K
93458 <1% 57 $10K
90715 <1% 485 $10K
70486 <1% 295 $10K
70491 <1% 186 $10K
42820 Tonsillectomy and adenoidectomy; younger than age 12 <1% 42 $9K
72126 <1% 193 $9K
90696 <1% 647 $9K
69210 <1% 232 $9K
99310 Prolong nursin fac eval 15m <1% 742 $9K
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg <1% 1,817 $9K
95909 <1% 87 $9K
90700 <1% 609 $9K
73110 <1% 1,261 $9K
73590 <1% 1,387 $9K
83655 <1% 692 $9K
49083 <1% 95 $9K
64494 <1% 185 $8K
90620 <1% 273 $8K
93298 <1% 565 $8K
73560 <1% 1,247 $8K
90619 <1% 400 $7K
99307 <1% 1,240 $7K
77061 <1% 163 $6K
76506 <1% 259 $6K
3078F <1% 1,716 $6K
73090 <1% 895 $6K
64483 <1% 63 $6K
0071A <1% 120 $5K
87426 Infectious agent antigen detection, SARS-CoV-2 (COVID-19) <1% 152 $5K
3074F <1% 1,306 $5K
76775 <1% 238 $5K
93975 <1% 133 $5K
93227 <1% 345 $4K
76818 <1% 48 $4K
80061 Lipid panel <1% 361 $4K
51701 <1% 143 $4K
76870 <1% 171 $4K
95911 <1% 26 $4K
43235 <1% 43 $4K
0072A <1% 92 $4K
73552 <1% 568 $4K
73100 <1% 445 $4K
94729 <1% 657 $4K
73080 <1% 508 $4K
72156 <1% 45 $4K
45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) <1% 25 $4K
73140 <1% 594 $3K
99000 <1% 5,102 $3K
95910 <1% 27 $3K
73221 <1% 65 $3K
G9001 Coordinated care fee, initial rate <1% 132 $3K
88720 <1% 676 $3K
73700 <1% 79 $3K
87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe <1% 63 $3K
95874 <1% 73 $3K
72128 <1% 77 $3K
99401 <1% 222 $3K
96160 <1% 1,271 $3K
95012 <1% 176 $2K
94726 <1% 217 $2K
95885 <1% 34 $2K
93320 <1% 54 $2K
99217 <1% 53 $2K
29075 <1% 26 $2K
36416 <1% 6,794 $2K
81003 <1% 999 $2K
76882 <1% 66 $2K
31575 <1% 26 $2K
70360 <1% 220 $2K
76700 Ultrasound, abdominal, real time with image documentation; complete <1% 54 $2K
29065 <1% 17 $2K
99292 <1% 18 $2K
99306 Prolong nursin fac eval 15m <1% 26 $2K
73070 <1% 224 $1K
72146 <1% 26 $1K
93296 <1% 113 $1K
99459 <1% 146 $1K
82962 <1% 635 $1K
72120 <1% 63 $1K
74022 <1% 119 $1K
20550 <1% 40 $1K
72197 <1% 14 $1K
72070 <1% 164 $1K
0002A <1% 30 $1K
0001A <1% 29 $1K
62321 <1% 17 $1K
95822 <1% 28 $1K
90732 <1% 14 $1K
82465 <1% 263 $1K
91320 <1% 12 $1K
20553 <1% 27 $990.36
73522 <1% 86 $965.38
90636 <1% 12 $959.88
11102 <1% 12 $930.35
99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity <1% 64 $927.59
82950 <1% 202 $868.79
0502F <1% 172 $800.00
90685 <1% 60 $735.84
90381 <1% 53 $697.21
90480 <1% 27 $684.00
77012 <1% 12 $671.91
77072 <1% 84 $654.00
99422 <1% 29 $635.50
81000 <1% 210 $620.12
76937 <1% 32 $611.62
0124A <1% 16 $573.43
99406 <1% 71 $565.26
G0463 Hospital outpatient clinic visit for assessment and management of a patient <1% 106 $563.04
11056 <1% 29 $502.72
76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete <1% 16 $500.73
93280 <1% 14 $492.07
73060 <1% 76 $485.46
93016 <1% 38 $479.11
70487 <1% 12 $468.31
93922 <1% 70 $468.00
93272 <1% 27 $463.26
76641 <1% 13 $452.49
73503 <1% 13 $445.70
74240 <1% 13 $416.80
76885 <1% 12 $390.15
77080 <1% 50 $381.28
99305 <1% 46 $375.37
93018 <1% 38 $330.19
90460 Immunization administration through 18 years of age via any route, first or only component <1% 53 $306.52
70250 <1% 46 $297.26
74300 <1% 19 $276.07
87210 <1% 57 $272.68
92504 <1% 15 $263.97
99051 <1% 2,127 $261.27
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg <1% 16 $256.65
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction <1% 15 $254.05
93926 <1% 16 $252.43
77073 <1% 12 $225.64
3075F <1% 28 $225.00
J1100 Injection, dexamethasone sodium phosphate, 1 mg <1% 458 $223.80
3044F <1% 73 $220.30
78264 <1% 12 $211.82
77001 <1% 13 $197.72
85025 Blood count; complete (CBC), automated, and automated differential WBC count <1% 39 $195.06
G0127 Trimming of dystrophic nails, any number <1% 59 $166.52
98960 <1% 14 $165.06
72081 <1% 14 $160.80
Q4010 Cast supplies, short arm cast, adult (11 years +), fiberglass <1% 13 $129.42
73000 <1% 18 $128.02
80047 <1% 14 $122.64
73120 <1% 15 $118.30
Q4012 Cast supplies, short arm cast, pediatric (0-10 years), fiberglass <1% 19 $112.01
73620 <1% 14 $105.20
85027 <1% 15 $101.60
51798 <1% 13 $101.06
73600 <1% 14 $98.53
Q4008 Cast supplies, long arm cast, pediatric (0-10 years), fiberglass <1% 13 $90.80
3046F <1% 15 $85.00
94760 <1% 41 $55.26
81005 <1% 13 $13.91
1126F <1% 290 $5.40
J7613 Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg <1% 38 $4.34
91307 <1% 267 $2.13
91300 <1% 143 $0.95
91305 <1% 26 $0.17
G1004 Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program <1% 43,593 $0.04
1159F 0% 2,841 $0.00
3100F 0% 77 $0.00
1125F 0% 78 $0.00
G0008 Administration of influenza virus vaccine 0% 14 $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 officialPRESCOTT, ELEANOR (GOVERNMENT PROGRAM MANAGER)
Same official

Other billing entities under PRESCOTT, ELEANOR

Full network →
ProviderLocationPaid
Carilion Medical CenterRoanoke, VA$124.86M
Carilion Healthcare CorporationRoanoke, VA$26.07M
Carilion Medical CenterRoanoke, VA$18.08M
Carilion Rockbridge Community HospitalLexington, VA$11.82M
Carilion Emergency Services, INC.Roanoke, VA$11.09M
Carilion Giles Community HospitalPearisburg, VA$10.32M
Carilion Tazewell Community HospitalTazewell, VA$8.03M
Carilion Medical CenterRoanoke, VA$7.31M
Carilion Giles Community HospitalPearisburg, VA$2.40M
Carilion Giles Community HospitalMartinsville, VA$1.99M
Carilion Giles Community HospitalGalax, VA$1.67M
Carilion Giles Community HospitalRocky Mount, VA$1.14M
Carilion Giles Community HospitalWytheville, VA$880K
Carilion Giles Community HospitalFloyd, VA$697K
Carilion Tazewell Community HospitalTazewell, VA$677K
Carilion Giles Community HospitalTazewell, VA$379K
Carilion Giles Community HospitalHillsville, VA$354K
Carilion Rockbridge Community HospitalBuchanan, VA$322K
Carilion Giles Community HospitalPearisburg, VA$254K
Carilion Rockbridge Community HospitalBedford, VA$241K

Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.