Loading...
NPI 1174533772 · Murfreesboro, TN · Physical Medicine & Rehabilitation Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Hemal Mehta is a physical medicine & rehabilitation physician provider located in Murfreesboro, Tennessee. This profile covers 2 Medicare and 7 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)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Hemal Mehta |
| Address | 2042 Lascassas Pike Ste A4 |
| City | Murfreesboro |
| State | TN |
| ZIP | 37130 |
| Taxonomy | Physical Medicine & Rehabilitation Physician |
| NPI Enumerated | August 8, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.5M |
| Medicaid | $5K |
Provider is effectively Medicare-focused: lifetime Medicare revenue is $4.5M versus Medicaid revenue of $5K, so the bulk of clinical billing and income is derived from Medicare rather than Medicaid, making this effectively a single-payer (Medicare) practice in scale. The NPI has been enumerated since 2006-08-08 (~20 years ago), so this pattern reflects a long-standing billing profile rather than a short-term fluctuation.
Medicare revenue is extremely concentrated: the top three Medicare codes account for 100.0% of the provider's total Medicare revenue, with Q4217 alone responsible for $4.5M (99.8% of Medicare revenue). This level of concentration indicates the practice’s Medicare business is overwhelmingly driven by a single procedure line rather than a diversified set of E/M or procedural codes.
Q4217 dominance points to an advanced wound-care specialty operation: the provider reported 5.3K claims for Q4217 with an average paid per claim of $852 and is billing an add-on biologic per square centimeter product as the core Medicare revenue driver. The presence of 15271 (skin substitute up to 100 cm2) alongside Q4217 further supports that the clinical activity centers on skin substitutes and graft-type wound interventions rather than routine outpatient E/M.
Competitive standing for the Medicare wound-care code is strong: Q4217 ranks #5 of 65 providers nationally (94th percentile; notably above typical national volume for this code), signaling the provider is a major national biller for this specific product. By contrast, 15271 ranks #474 of 1157 (59th percentile), indicating the provider’s strength is concentrated in the Q4217 product more than in the broader skin-substitute code mix.
Medicaid billing is small and concentrated: the top three Medicaid codes account for 84.4% of the provider's total Medicaid revenue, led by 99354 ($2.4K, 47.5%) and 99204 ($1.4K, 27.0%), with 96136 contributing $495 (9.9%). The Medicaid code mix suggests limited outpatient/prolonged service and diagnostic testing activity on Medicaid, but in absolute dollars this activity is minimal compared with Medicare.
The provider’s competitive position in Medicaid is modest to low: 99354 ranks #14 of 25 in-state (46th percentile; typical, unremarkable volume), 99204 ranks #714 of 1078 (34th percentile), and 96136 ranks #54 of 57 (5th percentile). These placements indicate the provider is not a leading Medicaid biller in Tennessee and that Medicaid-related services represent a small, secondary component of practice activity.
Several Medicaid codes produce negligible revenue or are at the bottom of state distributions: 80307 shows $0 revenue (0.0% of Medicaid revenue) and is ranked #235 of 236 in-state (0th percentile), while G0396 is ranked #45 of 46 (2th percentile). These items are operationally immaterial to the provider’s overall financial profile and underscore that Medicaid billing is sparse and sporadic for this clinician.
Long tenure with a concentrated revenue stream suggests an established, specialized operational model: being enumerated since 2006-08-08 (~20 years) and generating $4.5M in Medicare revenue predominantly from wound-care product code Q4217 implies sustained, high-volume delivery of that specific procedure over many years rather than a recently developed service line. This pattern is relevant for payers and competitors evaluating relationships, network value, or regional capacity for advanced wound-care products.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| Q4217 | Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter (add-on, list separately in addition to primary procedure) | 5,290 | $850 | $4.5M |
| 15271 | The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the patient’s trunk, arms, and/or legs up to an area of 100 cm2. This code covers up to the first 25 cm2. | 80 | $110 | $8.6K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99354 | N/A | 90 | $30 | $2.4K |
| 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… | 50 | $30 | $1.4K |
| 96136 | The provider, a physician or other qualified healthcare professional, administers two or more psychological or neuropsychological tests and scores them. Report this code for the first 30 minutes of… | 20 | $30 | $500 |
| 96160 | The provider administers a questionnaire aimed at helping to identify a specific health risk to a patient, analyzes the results, assigns a score, and documents the findings. Use this code for each… | 20 | $20 | $270 |
| G0396 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes | 20 | $20 | $270 |
| 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… | 20 | $20 | $240 |
| 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. | 10 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Tennessee providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Tennessee median
7 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. | 235 | 240 | 840 | $20 | $259.2K |
| 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… | 714 | 1,080 | 120 | $80 | $90.7K |
| 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… | 1,120 | 1,240 | 120 | $60 | $53.1K |
| 96160 | The provider administers a questionnaire aimed at helping to identify a specific health risk to a patient, analyzes the results, assigns a score, and documents the findings. Use this code for each… | 369 | 400 | 310 | $10 | $27.1K |
| 99354 | N/A | 14 | 30 | 130 | $20 | $18K |
| G0396 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes | 45 | 50 | 230 | $10 | $7.9K |
| 96136 | The provider, a physician or other qualified healthcare professional, administers two or more psychological or neuropsychological tests and scores them. Report this code for the first 30 minutes of… | 54 | 60 | 200 | $10 | $7.9K |
Other providers in the same ZIP code as Hemal Mehta, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| County Of Rutherford Office Of Budget Director | TN | Land Ambulance | $2.3M | $8M |
| Mckee, Curry, Stanley, Pediatric Dentistry Partnership | TN | Pediatric Dentistry | $0 | $6.3M |
| Special Kids Inc | TN | Physical Therapist | $0 | $6.2M |
| Center For Excellence | TN | Adult Mental Health Clinic/Center | $0 | $3.9M |
| Ronald Nelson | TN | Dermatology Physician | $336K | $0 |
| James Garner | TN | Internal Medicine Physician | $166.3K | $0 |
| Nicholas Dieringer | TN | Internal Medicine Physician | $127.6K | $1.1K |
| Joseph Weathersby | TN | Physician Assistant | $96.6K | $0 |
| Charles Goodman | TN | Dermatology Physician | $95.8K | $0 |
| Beckmans Prescription Shop | TN | Durable Medical Equipment & Medical Supplies | $90.5K | $0 |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.