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

Why is the Medicaid comparison limited to New Mexico 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 Mexico (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.

Optumcare New Mexico LLC (NPI 1124053210)

Optumcare New Mexico LLC is a family medicine physician provider located in Albuquerque, New Mexico. This profile covers 0 Medicare and 193 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	Optumcare New Mexico LLC
Address	2901 Transport St Se
City	Albuquerque
State	NM
ZIP	87106
Taxonomy	Family Medicine Physician
NPI Enumerated	July 11, 2006

Payer Source	Total Paid
Medicaid	$23.6M
Medicare	$0

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

193 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…	78,780	$80	$6.5M
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…	58,200	$70	$4M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	33,010	$50	$1.7M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	13,370	$120	$1.5M
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	17,120	$90	$1.5M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	12,110	$120	$1.4M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	11,060	$110	$1.2M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	8,080	$120	$929.7K
99173	The provider checks the eyesight in both eyes of a pediatric patient by asking him to read letters of varying sizes on a standard chart, such as a Snellen’s chart, which he keeps 20 feet away from…	19,780	$40	$751.6K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	24,490	$20	$416.3K

Showing 1–10 of 193

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Optumcare New Mexico LLC — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

193 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	Injection, aflibercept, 1 mg	8	10	480	$1,280	$3.2M
J0585	Injection, onabotulinumtoxina, 1 unit	11	20	810	$520	$1.6M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	37	140	130	$220	$568.5K
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…	14	930	910	$80	$521.6K
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…	10	960	1,010	$90	$490K
J0129	Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	2	10	140	$1,550	$470.9K
J7323	Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	4	10	990	$280	$373.9K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	34	50	1,760	$100	$364.2K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	6	100	1,100	$110	$362K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	41	70	970	$140	$356.3K

Showing 1–10 of 193

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jamie Giesbrandt	NM	Diagnostic Radiology Physician	$385.5K	$0
Monish Merchant	FL	Vascular & Interventional Radiology Physician	$306.8K	$120
Johnathan Hays	VA	Diagnostic Radiology Physician	$275K	$32K
Pedro Ortiz	AZ	Cardiovascular Disease Physician	$263.3K	$0
Nishiena Gandhi	NM	Neurology Physician	$149.8K	$0
Evan Johnson	WA	Vascular & Interventional Radiology Physician	$135.8K	$10.8K
Monik Lala	MI	Diagnostic Radiology Physician	$132.4K	$0
Dennis Garcia	NM	Family Medicine Physician	$110.4K	$0
Zachary Redus	OH	Diagnostic Radiology Physician	$99.7K	$0
Robert Taylor	NM	Cardiovascular Disease Physician	$95.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Unm Hospital	NM	General Acute Care Hospital	$0	$462.9M
Presbyterian Healthcare Services	NM	General Acute Care Hospital	$0	$345.3M
Unm Medical Group Inc	NM	Multi-Specialty Clinic/Center	$0	$113.5M
Dungarvin New Mexico LLC	NM	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$84.6M
Perinatal Associates Of New Mexico, Ltd	NM	Maternal & Fetal Medicine Physician	$0	$62.6M
Unm Hospital	NM	Psychiatric Hospital Unit	$228.5K	$17.6M
Family Eye Care/children's Eye Center Of New Mexico, P.C.	NM	Ophthalmology Physician	$0	$13.3M
Pediatrix Medical Group Of New Mexico, P.C.	NM	Neonatal-Perinatal Medicine Physician	$0	$11.9M
Guardian Flight LLC	NM	Air Ambulance	$372.6K	$6.9M
Climbing Tree Therapy, Inc.	NM	Occupational Therapist	$0	$6.6M

Optumcare New Mexico LLC — Billing Profile & Reimbursement Data

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Optumcare New Mexico LLC — 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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