Public Medicare billing profile
Faisal Sheikh, D.O.
Gastroenterology · Syosset, NY · NPI 1114188000
Medicare allowed
$793,087
Services
7,641
Top 5 codes are
96%
96% 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 |
|---|---|---|---|---|
| 99232facility | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 5,329 | $116.70 | $87.14 |
| 99223facility | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 1,020 | $248.56 | $191.86 |
| 99497facility | Advance care planning, first 30 minutes | 1,015 | $107.26 | $83.34 |
| 43239facility | Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope | 90 | $197.86 | $132.97 |
| 99291facility | Critical care, first 30-74 minutes | 31 | $301.15 | $237.02 |
| 99285facility | Emergency department visit with high level of medical decision making | 36 | $250.10 | $195.42 |
| 45380facility | Biopsy of large bowel using a flexible endoscope | 31 | $287.30 | $200.02 |
| 43246facility | Insertion of stomach tube using a flexible endoscope | 23 | $291.76 | $228.77 |
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.
The report is free, needs no signup, and the file never leaves your browser. Open your network tab before you drop it and you will see no request.
Two things specific to your mix
- 100% of your allowed dollars are billed at a facility place of service. Facility rates are materially lower than office rates for the same work, because the practice expense sits with the facility. Worth confirming the split is intentional on every code.
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 1114188000. Beneficiary counts overlap across codes, so we do not add them up.
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