Pennsylvania

Medicare Revenue Gap Analysis

42.2K

Medicare Providers

2.6M

Beneficiaries

$92.2K

Avg Missed/Provider

$3890.8M

Total State Gap

Revenue Gap Breakdown

E&M Coding Gap

$26.0K/yr

Average undercoding gap from 99213→99214 shifts

CCM Revenue Gap

$29.5K/yr

10% adoption rate — national benchmark: 15%

RPM Revenue Gap

$20.3K/yr

6% adoption rate — national benchmark: 8%

AWV Revenue Gap

$12.9K/yr

46% completion rate — target: 70%+

BHI Revenue Gap

$7.4K/yr

Behavioral health integration opportunity

Top Cities in Pennsylvania

#1

Philadelphia

11,400 providers

Est. gap: $893.4M

#2

Pittsburgh

6,840 providers

Est. gap: $536.1M

#3

Allentown

2,120 providers

Est. gap: $166.1M

#4

Hershey

1,640 providers

Est. gap: $128.5M

#5

Lancaster

1,280 providers

Est. gap: $100.3M

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