Public Medicare billing profile
Douglas Petraco, MD
Orthopedic Surgery · East Setauket, NY · NPI 1922021476
Medicare allowed
$957,444
Services
96,382
Top 5 codes are
72%
72% of your Medicare revenue sits in five codes
That concentration is the useful part. It means a few percent of variance on a handful of codes moves real money, and it means checking whether you are being paid correctly is a small job rather than an audit of everything you bill.
| Code | Service | Volume | You charge | Medicare allows |
|---|---|---|---|---|
| 20611 | Aspiration and/or injection of fluid large joint using ultrasound guidance | 1,426 | $801.68 | $134.07 |
| 27447facility | Replacement of knee joint, both sides of knee | 122 | $22,815.01 | $1,503.98 |
| 27130facility | Replacement of thigh bone and hip joint with prosthesis | 83 | $16,369.99 | $1,522.27 |
| J7329 | Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg | 13,502 | $100.00 | $7.08 |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 617 | $502.32 | $145.57 |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 671 | $375.20 | $103.36 |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | 219 | $790.24 | $189.24 |
| 73564 | X-ray of knee, 4 or more views | 410 | $212.54 | $68.61 |
Ranked by total Medicare allowed. Allowed amounts are already adjusted by CMS for your locality.
Here is what this does not tell you
CMS publishes what Medicare allowed you. It publishes nothing about what Aetna, Cigna, United or your Blues plan allowed for the same codes. Commercial contracts are conventionally written as a percentage of Medicare and normally sit above it, so the numbers in that table are a floor your commercial payers should clear.
Most practices have never checked. A claim paid at 70% of the allowable does not show up as a denial or land in anyone's work queue. It shows up as paid.
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Where these numbers come from
Medicare Physician & Other Practitioners, by Provider and Service, published by the Centers for Medicare & Medicaid Services. It is public data covering Part B fee-for-service claims. Service descriptions are CMS's own.
Nothing here is modelled and nothing is an estimate of what you could recover. The totals are sums of what CMS published for NPI 1922021476. Beneficiary counts overlap across codes, so we do not add them up.
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