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 South Carolina for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

Hugh James (NPI 1053375592)

Hugh James is a surgery physician provider located in Spartanburg, South Carolina. 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	Hugh James
Address	100 E Wood St
City	Spartanburg
State	SC
ZIP	29303
Taxonomy	Surgery Physician
NPI Enumerated	April 13, 2006

Payer Source	Total Paid
Medicare	$56.2K
Medicaid	$0

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
43282	The provider performs repair of a paraesophageal hernia, where the stomach slides up next to the esophagus, using laparoscopy. He may also perform fundoplasty, wrapping part of the stomach around the…	10	$1,300	$18.2K
99215	The provider sees an established 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…	80	$130	$9.8K
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…	60	$150	$8.4K
49650	The provider performs laparoscopic repair of an initial inguinal hernia.	10	$310	$4.4K
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…	50	$90	$4.3K
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…	30	$120	$3.5K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	10	$130	$1.6K
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…	20	$70	$1.6K
45384	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions using hot biopsy…	10	$130	$1.4K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	20	$60	$1.2K

Showing 1–10 of 12

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	6,036	7,860	160	$80	$23.2K
43282	6	10	20	$950	$19K
99232	2,589	2,780	90	$60	$12K
99213	6,626	7,690	100	$60	$10.8K
99215	678	2,360	40	$120	$9.3K
49650	38	50	20	$400	$8.4K
99223	1,971	2,080	40	$130	$8.3K
99204	2,802	4,520	40	$110	$6.4K
45384	27	30	20	$190	$6.1K
99205	199	1,000	30	$150	$5.8K

Hugh James — Billing Profile & Reimbursement Data

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Hugh James — 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