Public Medicare billing profile
Peter Legnani, MD
Gastroenterology · New York, NY · NPI 1942219548
Medicare allowed
$809,772
Services
33,030
Top 5 codes are
95%
95% 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 |
|---|---|---|---|---|
| J3380 | Injection, vedolizumab, intravenous, 1 mg | 32,100 | $40.16 | $21.96 |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 209 | $400.00 | $151.27 |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 127 | $375.00 | $107.52 |
| 45385facility | Removal of polyps or growths of large bowel using an endoscope with mechanical snare | 37 | $2,100.00 | $293.07 |
| 45380facility | Biopsy of large bowel using a flexible endoscope | 68 | $2,050.00 | $155.67 |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 64 | $550.00 | $157.63 |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 113 | $300.00 | $76.27 |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | 31 | $500.00 | $195.98 |
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
- 87% of your Medicare allowed is drug codes. Buy-and-bill reimbursement moves with the ASP file, which CMS republishes every quarter. A payer still paying last quarter's rate is a four-figure variance per administration, and it never appears as a denial.
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 1942219548. Beneficiary counts overlap across codes, so we do not add them up.
If something is wrong or you would rather this page not exist, tell us and we will correct or remove it.