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

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

Kentucky Orthopaedics & Spine PLLC (NPI 1083185938)

Kentucky Orthopaedics & Spine PLLC is a orthopaedic surgery physician provider located in Winchester, Kentucky. This profile covers 0 Medicare and 50 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	Kentucky Orthopaedics & Spine PLLC
Address	404 Shoppers Dr
City	Winchester
State	KY
ZIP	40391
Taxonomy	Orthopaedic Surgery Physician
NPI Enumerated	December 17, 2018

Payer Source	Total Paid
Medicaid	$4.6M
Medicare	$0

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

50 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	28,690	$40	$1.1M
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…	14,170	$70	$949.7K
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…	36,840	$20	$810.4K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	15,760	$30	$425.4K
72148	In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the lumbar spinal canal and contents without using contrast.	770	$300	$230.7K
62323	The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)…	1,530	$130	$204.5K
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…	1,980	$50	$106.9K
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…	720	$120	$88.9K
73721	In this diagnostic procedure, the provider performs magnetic resonance imaging of a lower extremity joint without using contrast material.	270	$290	$76.6K
72100	The technician takes 2 or 3 views of the vertebrae in the lumbar region which is the lower part of the spine and the sacrum, the area that connects the spine to the pelvis. Lumbosacral spine X–rays…	3,960	$20	$63.3K

Showing 1–10 of 50

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Kentucky Orthopaedics & Spine PLLC — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

50 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	259	340	2,700	$40	$673.3K
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…	174	3,340	1,020	$30	$296K
72148	In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the lumbar spinal canal and contents without using contrast.	54	140	390	$250	$279.4K
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…	76	2,460	580	$40	$245K
72141	In this diagnostic procedure, the provider performs a magnetic resonance imaging (MRI) study of the cervical spinal canal and contents without using contrast material.	44	80	180	$310	$185K
62323	The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)…	16	80	260	$190	$182.3K
64635	Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue.	15	40	80	$330	$181.6K
73721	In this diagnostic procedure, the provider performs magnetic resonance imaging of a lower extremity joint without using contrast material.	54	110	290	$240	$178.6K
72158	In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the lumbar spinal canal and contents first without using contrast and again after injecting contrast material.	14	10	100	$560	$168.8K
64721	Neuroplasty or transposition of the median nerve at the carpal tunnel is done to treat a condition called carpal tunnel syndrome (CTS). The carpal tunnel is a narrow tunnel in the wrist through which…	12	20	50	$680	$140.1K

Showing 1–10 of 50

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jason Delong	KY	Physician Assistant	$180.1K	$0
James Rice	KY	Orthopaedic Surgery Physician	$173.9K	$0
Michael Bradley	KY	Physician Assistant	$149.2K	$810
Brandon Embry	KY	Medical Physician Assistant	$134K	$0
Kurt Schlenther	KY	Physician Assistant	$115.7K	$710
Gregory Grau	KY	Orthopaedic Surgery Physician	$111.6K	$0
James Farris	KY	Physician Assistant	$57.7K	$0
Amy Barko	KY	Foot & Ankle Surgery Podiatrist	$51.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kentucky Hospital, LLC	KY	General Acute Care Hospital	$0	$83.8M
Kentucky Addiction Centers, LLC	KY	Substance Abuse Rehabilitation Facility	$0	$16.7M
Dungarvin Kentucky, LLC - Winchester	KY	Developmentally Disabled Services Day Training Agency	$0	$13.4M
Caky E Winchester	KY	Case Management Agency	$0	$12.1M
New Day Recovery Center	KY	Substance Abuse Rehabilitation Facility	$0	$10.6M
Clark Regional Physician Practices, LLC	KY	Durable Medical Equipment & Medical Supplies	$0	$9.4M
John I. Gray, Iii, Psc	KY	Oral and Maxillofacial Surgery (Dentist)	$0	$7.1M
Clark Emergency Physicians	KY	Emergency Medicine Physician	$0	$6.7M
Beall Recovery Clinics	KY	Addiction Medicine (Preventive Medicine) Physician	$0	$5M
Timothy Crisp	KY	Pediatric Dentistry	$0	$4.4M

Kentucky Orthopaedics & Spine PLLC — Billing Profile & Reimbursement Data

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Kentucky Orthopaedics & Spine PLLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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