Public Medicare billing profile
Frank Lombardo, M.D.
Orthopedic Surgery · Poughkeepsie, NY · NPI 1811161805
Medicare allowed
$666,384
Services
11,128
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 | 1,163 | $573.23 | $100.23 |
| 27447facility | Replacement of knee joint, both sides of knee | 89 | $9,445.00 | $1,298.79 |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 685 | $341.00 | $129.21 |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 948 | $231.83 | $91.94 |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose | 586 | $219.46 | $118.82 |
| 27130facility | Replacement of thigh bone and hip joint with prosthesis | 53 | $9,156.00 | $1,306.92 |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | 115 | $528.00 | $169.43 |
| 73721 | Mri scan of leg joint without contrast | 81 | $1,992.62 | $207.33 |
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 1811161805. Beneficiary counts overlap across codes, so we do not add them up.
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