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

Why is the Medicaid comparison limited to Puerto Rico 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. Puerto Rico (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.

Lionel Lugo (NPI 1164423828)

Field	Value
Entity Type	Individual
Organization	Lionel Lugo
Address	Hospital San Lucas I
City	Ponce
State	PR
ZIP	00731
Taxonomy	Specialist
NPI Enumerated	August 3, 2005

Payer Source	Total Paid
Medicaid	$837.7K
Medicare	$0

Medicaid: Complete Services Breakdown

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
92511	The provider examines the nasal passages and throat with an endoscope, a tubular instrument with a light source and camera.	2,990	$90	$272.2K
31233	The provider perforates the canine fossa or inferior meatus to advance an endoscope into the maxillary sinus. She then opens the maxillary sinus to perform a diagnostic endoscopy.	1,440	$150	$214.6K
92557	The provider assesses a patient’s hearing with a series of tones at varying intensities to identify the softest level at which the patient can hear. He also measures the patient’s ability to…	2,320	$30	$72K
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…	2,610	$30	$70.3K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	600	$100	$62.3K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	1,460	$40	$54.2K
69450	The provider destroys adhesions, or scar tissue, on the tympanic membrane, or ear drum, that interfere with hearing.	70	$700	$48K
92567	In this procedure, the provider measures the functioning of the middle ear by varying the pressure of air presented to the ear to identify the reason for hearing loss.	3,010	$10	$39.1K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	120	$20	$2.5K
99201	Deleted code, effective Jan. 1, 2021	30	$20	$780

Showing 1–10 of 14

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Puerto Rico Distribution

Lionel Lugo — 3 of 14 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. Puerto Rico median

14 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
31233	The provider perforates the canine fossa or inferior meatus to advance an endoscope into the maxillary sinus. She then opens the maxillary sinus to perform a diagnostic endoscopy.	1	10	530	$190	$128.1K
92511	The provider examines the nasal passages and throat with an endoscope, a tubular instrument with a light source and camera.	1	10	190	$90	$78K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	2	20	170	$150	$48.6K
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…	638	3,230	330	$10	$42.4K
69450	The provider destroys adhesions, or scar tissue, on the tympanic membrane, or ear drum, that interfere with hearing.	1	10	70	$450	$30.2K
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…	1,116	1,400	160	$50	$29.6K
92557	The provider assesses a patient’s hearing with a series of tones at varying intensities to identify the softest level at which the patient can hear. He also measures the patient’s ability to…	5	50	410	$30	$27.8K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	20	150	110	$30	$24.3K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	543	840	340	$1	$16.7K
92567	In this procedure, the provider measures the functioning of the middle ear by varying the pressure of air presented to the ear to identify the reason for hearing loss.	2	20	110	$10	$12.8K

Showing 1–10 of 14

Nearby Providers

Other providers in the same ZIP code as Lionel Lugo, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Puerto Rico Medical Emergency Group P.s.c.	PR	Emergency Medicine Physician	$0	$8.2M
Southern Anesthesia Associates LLC	PR	Specialist	$0	$1.4M
First Choice Prosthetic & Otrhopedic Service Inc	PR	Customized Equipment (DME)	$0	$1.3M
Amilcar Rodriguez Melendez	PR	General Practice Dentistry	$0	$877.7K
Humberto Simonetti	PR	Internal Medicine Physician	$18.3K	$250.7K
Monica Portalatin Perez	PR	General Practice Physician	$2.2K	$0

Lionel Lugo — Billing Profile & Reimbursement Data

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Lionel Lugo — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References