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

Why is the Medicaid comparison limited to Tennessee 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. Tennessee (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.

Orthotennessee, PC (NPI 1053402040)

Orthotennessee, PC is a orthopaedic surgery physician provider located in Knoxville, Tennessee. This profile covers 0 Medicare and 54 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Orthotennessee, PC
Address	260 Fort Sanders West Blvd
City	Knoxville
State	TN
ZIP	37922
Taxonomy	Orthopaedic Surgery Physician
NPI Enumerated	September 27, 2006

Payer Source	Total Paid
Medicaid	$7.2M
Medicare	$0

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

54 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	61,530	$50	$2.8M
99203	The provider sees a new 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 provider…	22,470	$80	$1.7M
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…	15,460	$60	$912.3K
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…	1,980	$110	$207.4K
73100	In this procedure, the provider takes two X–ray images of a patient’s wrist to check for any fracture, swelling, or reason of pain in the wrist area.	6,560	$30	$163.9K
73610	In this procedure, the provider takes three or more X–ray images of the ankle joint to check for any fracture, swelling, or reason for pain in the ankle area.	6,140	$20	$147.5K
25600	The provider treats a fracture of the wrist end of the radius, one of the bones in the forearm, in which the fracture fragment displaces upward or downward, in a closed procedure. The growth plate at…	480	$260	$124.8K
72082	In this diagnostic procedure, the provider takes X–ray images from two or three projections (directions or angles) of the entire thoracic (upper and middle) and lumbar (lower) spine to evaluate the…	2,150	$50	$111.6K
73090	In this procedure, the provider takes two X–ray views of a patient’s forearm to check for any fracture, swelling, or reason of pain in the forearm area.	4,040	$20	$96.8K
73630	In this diagnostic procedure, the provider takes a minimum of three views of the foot to assess injury, fracture, arthritis, tumor, or congenital abnormality.	4,280	$20	$89.9K

Showing 1–10 of 54

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Tennessee providers billing the same CPT/HCPCS codes.

Claims Volume vs. Tennessee Distribution

Orthotennessee, PC — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

54 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	212	3,760	610	$40	$202.3K
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…	65	4,050	620	$30	$183.9K
25600	The provider treats a fracture of the wrist end of the radius, one of the bones in the forearm, in which the fracture fragment displaces upward or downward, in a closed procedure. The growth plate at…	1	10	480	$260	$125K
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…	88	1,080	120	$80	$90.7K
L4361	Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf	18	30	90	$140	$68.3K
64493	The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance…	45	60	150	$80	$57.9K
99203	The provider sees a new 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 provider…	8	1,240	120	$60	$53.1K
64483	This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral).	15	40	210	$90	$49.7K
20611	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa, typically the shoulder, hip, knee, or subacromial bursa, and then uses the syringe…	21	50	140	$30	$38.8K
73721	In this diagnostic procedure, the provider performs magnetic resonance imaging of a lower extremity joint without using contrast material.	39	50	100	$80	$38.3K

Showing 1–10 of 54

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gi For Kids, PLLC	TN	Pediatric Gastroenterology Physician	$0	$18.9M
Children's West Surgery Center	TN	Ambulatory Surgical Clinic/Center	$0	$10M
C A H Managment Company, LLC	TN	Urgent Care Clinic/Center	$0	$9.8M
Rocky Top Pediatric Dentistry, LLC	TN	Pediatric Dentistry	$0	$4.6M
Knoxville Eye Surgery Center LLC	TN	Ambulatory Surgical Clinic/Center	$4.1M	$180
Knoxville Orthopaedic Surgery Center LLC	TN	Ambulatory Surgical Clinic/Center	$3.1M	$19.1K
Knoxville Dermatology Group PC	TN	Dermatology Physician	$0	$3.1M
Recovery Strategies LLC	TN	Substance Use Disorder Rehabilitation Clinic/Center	$0	$2.8M
Fort Sanders West Op Surgery Center	TN	Ambulatory Surgical Clinic/Center	$2.1M	$10
Kimberly Grande	TN	Specialist	$963.5K	$0

Orthotennessee, PC — Billing Profile & Reimbursement Data

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Orthotennessee, PC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Herman Botero	TN	Orthopaedic Surgery Physician	$440.9K	$0
Bruce Fry	TN	Physical Medicine & Rehabilitation Physician	$316.8K	$0
Matthew Nadaud	TN	Orthopaedic Surgery Physician	$295.4K	$0
Paul Johnson	TN	Orthopaedic Surgery Physician	$256.2K	$0
Brian Dilworth	TN	Orthopaedic Surgery Physician	$244.1K	$0
Robert Ivy	TN	Orthopaedic Hand Surgery Physician	$231.7K	$0
Michael Mccollum	TN	Orthopaedic Surgery Physician	$230K	$0
Michael Craig	TN	Physical Medicine & Rehabilitation Physician	$227.9K	$0
James Sherrell	TN	Orthopaedic Surgery Physician	$211.2K	$0
Edwin Spencer	TN	Orthopaedic Surgery Physician	$196.2K	$0