Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or New York for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to New York only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. New York (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Michael Lowe (NPI 1013193507)

Michael Lowe is a surgical oncology physician provider located in New York, New York. This profile covers 12 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Provider details (source: NPPES NPI Registry)

Medicare: Complete Services Breakdown

Field	Value
Entity Type	Individual
Organization	Michael Lowe
Address	1275 York Ave # H-1206
City	New York
State	NY
ZIP	10065
Taxonomy	Surgical Oncology Physician
NPI Enumerated	January 14, 2008

Payer Source	Total Paid
Medicare	$41.7K
Medicaid	$0

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
38525	The provider surgically removes the lymph nodes in the deep axilla through an open incision. He may send them to the laboratory for analysis. The provider performs the procedure as an investigation…	20	$360	$7.5K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	120	$60	$7.1K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	60	$130	$6.9K
38900	The provider injects a nonradioactive dye into the tissues surrounding the lymph nodes. The provider examines the lymph nodes during the procedure to detect the presence of disease and identify the…	40	$110	$4K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	40	$80	$3.3K
38500	The provider performs an open excision or biopsy of the lymph nodes lying near the surface of the body using a scalpel. The provider commonly performs this procedure to identify and diagnose the…	20	$170	$3K
13121	This is for a complex repair of a wound to the scalp, arms, and/or legs. This wound should be 2.6 to 7.5 cm in size.	20	$120	$2.8K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	20	$150	$2.4K
13122	This is for a complex repair of a wound to the scalp, arms, and/or legs. This code is for each additional 5 cm or less, in addition to the primary wound. This CPT code is listed separately to denote…	20	$70	$1.5K
11603	The provider excises a cancerous (malignant) lesion, including margins, of 2.1 to 3.0 cm in diameter, from the skin of the trunk, arms, or legs.	20	$80	$1.4K

Showing 1–10 of 12

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	22,552	30,450	90	$100	$19K
13121	103	160	30	$260	$13.3K
99213	12,159	31,440	80	$70	$12.1K
99204	4,063	14,170	30	$130	$6.6K
99205	3,105	4,260	30	$180	$6.4K
38525	30	90	20	$240	$4.8K
11623	5	10	20	$160	$3.9K
99212	6,378	7,850	30	$40	$3.6K
11603	45	90	20	$140	$3.6K
13122	7	20	20	$110	$3.3K

Michael Lowe — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References