Public Medicare billing profile
Justin Paul, M.D., PH.D.
Orthopedic Surgery · New York, NY · NPI 1881911006
Medicare allowed
$705,677
Services
1,360
Top 5 codes are
91%
91% 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 |
|---|---|---|---|---|
| 22514 | Treatment of broken lower spine bone with placement of stabilizing device | 41 | $33,000.00 | $5,974.68 |
| 22513 | Treatment of broken middle spine bone with placement of stabilizing device using imaging guidance | 33 | $33,000.00 | $6,003.22 |
| 22515 | Treatment of broken spine bone with stabilizing device, each additional segment | 41 | $33,000.00 | $3,071.42 |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 556 | $159.00 | $94.79 |
| 22612facility | Fusion of spine in lower back | 12 | $9,907.00 | $1,679.78 |
| 63047facility | Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 segment | 12 | $6,901.00 | $937.69 |
| 22845facility | Placement of stabilizing device to front, 2-3 spine bone segments | 14 | $4,591.00 | $729.04 |
| 22853facility | Insertion of cage or mesh device to spine bone and disc space during spine fusion | 30 | $1,557.00 | $263.00 |
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 1881911006. Beneficiary counts overlap across codes, so we do not add them up.
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