Hospital
Prisma Health-Upstate
Prisma Health-Upstate was paid $10.74M by Medicaid between Jan 2018 and Dec 2024, across 95 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 15% of everything it billed.
33Billing provider infoPRISMA HEALTH-UPSTATE
GREENVILLE, SC 29611
GREENVILLE, SC 29611
33aNPI1851846661assigned 08/22/2016
33bProvider typeGeneral Acute Care Hospital
28Total paid$10.74M
24GClaims208,621
24DCodes billed95
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other General Acute Care Hospital providers in South Carolina
Rank by total paid#31 of 115
Median peer was paid$2.47M
This provider vs. median4.4×
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.
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 | 32,118 | $1.78M | |
| 2019 | 34,261 | $2.23M | |
| 2020 | 31,455 | $1.74M | |
| 2021 | 26,463 | $1.17M | |
| 2022 | 24,615 | $1.09M | |
| 2023 | 20,664 | $995K | |
| 2024incomplete | 39,045 | $1.74M |
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 | 15% | 21,319 | 19,709 | $1.64M |
| 94760 | 10% | 12,415 | 11,572 | $1.11M | |
| 36415 | Collection of venous blood by venipuncture | 8.9% | 6,091 | 5,882 | $956K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 8.6% | 10,814 | 10,027 | $921K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 7.6% | 9,102 | 8,498 | $814K |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | 7.1% | 363 | 289 | $758K |
| 99215 | Doctor's office visit, returning patient (complex)Prolong outpt/office vis | 5.7% | 1,182 | 1,107 | $608K |
| 83655 | 5.2% | 4,205 | 4,127 | $559K | |
| 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 | 4.7% | 10,533 | 9,769 | $509K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 4.6% | 7,034 | 6,959 | $489K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 3.7% | 9,821 | 9,687 | $396K |
| C9803 | Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 2.8% | 1,906 | 1,873 | $304K |
83 more codes
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | 2.4% | 2,759 | $261K |
| 99188 | 2.3% | 4,496 | $242K | |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 2.1% | 3,641 | $224K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | 1.8% | 2,512 | $193K |
| 99174 | 1.5% | 1,534 | $162K | |
| 85018 | <1% | 4,567 | $67K | |
| 87070 | <1% | 431 | $66K | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 689 | $55K |
| 81003 | <1% | 1,072 | $48K | |
| 96127 | <1% | 451 | $44K | |
| 0202U | Oncology (prostate), multianalyte, gene expression profiling | <1% | 169 | $37K |
| 96161 | <1% | 344 | $36K | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 936 | $26K |
| 87081 | <1% | 221 | $21K | |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | <1% | 820 | $15K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | <1% | 21,280 | $14K |
| 90686 | <1% | 8,301 | $13K | |
| 88720 | <1% | 84 | $12K | |
| 87637 | Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV | <1% | 86 | $11K |
| 90677 | <1% | 1,810 | $9K | |
| 87086 | Culture, bacterial; quantitative colony count, urine | <1% | 175 | $9K |
| 85027 | <1% | 861 | $9K | |
| 99177 | <1% | 67 | $8K | |
| 87636 | Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B | <1% | 57 | $8K |
| 90461 | <1% | 5,542 | $8K | |
| 85007 | <1% | 261 | $7K | |
| 80053 | Comprehensive metabolic panel | <1% | 2,288 | $6K |
| 99173 | <1% | 53 | $5K | |
| 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% | 1,139 | $5K |
| 82247 | <1% | 60 | $5K | |
| 94664 | <1% | 83 | $4K | |
| 96160 | <1% | 407 | $4K | |
| 90633 | <1% | 4,267 | $4K | |
| 90670 | <1% | 5,646 | $3K | |
| 90656 | <1% | 1,495 | $3K | |
| 80061 | Lipid panel | <1% | 3,159 | $3K |
| 87077 | <1% | 25 | $3K | |
| 94761 | <1% | 107 | $2K | |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | <1% | 42 | $2K |
| 90696 | <1% | 1,901 | $2K | |
| 0072A | <1% | 62 | $2K | |
| 84443 | Thyroid stimulating hormone (TSH) | <1% | 291 | $1K |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | <1% | 49 | $1K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | <1% | 445 | $1K |
| 0071A | <1% | 136 | $868.25 | |
| 82728 | <1% | 25 | $788.33 | |
| 90651 | <1% | 2,581 | $737.76 | |
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 2,168 | $722.86 |
| 90698 | <1% | 2,886 | $497.28 | |
| 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% | 340 | $340.82 |
| 90619 | <1% | 867 | $324.24 | |
| 90715 | <1% | 1,177 | $293.19 | |
| 0001A | <1% | 29 | $256.04 | |
| 90680 | <1% | 3,975 | $196.99 | |
| 90647 | <1% | 1,278 | $181.20 | |
| 83540 | <1% | 19 | $154.29 | |
| 90621 | <1% | 433 | $152.24 | |
| 90707 | <1% | 2,039 | $147.37 | |
| 94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction | <1% | 12 | $123.41 |
| 90710 | <1% | 1,789 | $117.13 | |
| 0082A | <1% | 13 | $102.63 | |
| 0081A | <1% | 33 | $70.04 | |
| 90716 | <1% | 2,015 | $52.48 | |
| 90480 | <1% | 160 | $37.49 | |
| 90700 | <1% | 492 | $34.32 | |
| 90697 | <1% | 2,115 | $20.21 | |
| 90744 | <1% | 1,536 | $20.21 | |
| 90734 | <1% | 1,107 | $0.01 | |
| 90723 | 0% | 1,257 | $0.00 | |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 0% | 48 | $0.00 |
| 90378 | 0% | 275 | $0.00 | |
| 96380 | 0% | 42 | $0.00 | |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | 0% | 26 | $0.00 |
| 91318 | 0% | 43 | $0.00 | |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | 0% | 48 | $0.00 |
| 90381 | 0% | 22 | $0.00 | |
| 90620 | 0% | 14 | $0.00 | |
| 82248 | 0% | 56 | $0.00 | |
| 84460 | 0% | 15 | $0.00 | |
| 80076 | 0% | 31 | $0.00 | |
| 90648 | 0% | 15 | $0.00 | |
| 84450 | 0% | 15 | $0.00 | |
| 84466 | 0% | 19 | $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 |
| 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.