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.

Knoxville Pediatric Ophthalmology, PLLC (NPI 1174831887)

Knoxville Pediatric Ophthalmology, PLLC is a ophthalmology physician provider located in Knoxville, Tennessee. This profile covers 0 Medicare and 20 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	Knoxville Pediatric Ophthalmology, PLLC
Address	2100 W Clinch Ave
City	Knoxville
State	TN
ZIP	37916
Taxonomy	Ophthalmology Physician
NPI Enumerated	September 15, 2010

Payer Source	Total Paid
Medicaid	$3.3M
Medicare	$0

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

20 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	10,430	$70	$688.1K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	5,390	$90	$501.5K
92060	The basic eye sensorimotor exam checks the alignment of the eyes and their ability to move together in eight fields of gaze ( up, down, right, left, up–left, up–right, down–left, down–right) and…	10,360	$30	$341.7K
92015	The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced.	11,660	$30	$338.2K
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…	2,930	$100	$287.2K
V2784	Lens, polycarbonate or equal, any index, per lens	3,630	$70	$239.5K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	4,340	$50	$212.7K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	7,500	$30	$202.6K
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…	2,850	$60	$173.8K
V2100	Sphere, single vision, plano to plus or minus 4.00, per lens	6,380	$20	$121.3K

Showing 1–10 of 20

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

Knoxville Pediatric Ophthalmology, PLLC — 8 of 18 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

20 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…	894	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…	932	4,050	620	$30	$183.9K
92060	The basic eye sensorimotor exam checks the alignment of the eyes and their ability to move together in eight fields of gaze ( up, down, right, left, up–left, up–right, down–left, down–right) and…	3	40	660	$40	$92.1K
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…	63	1,080	120	$80	$90.7K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	13	710	340	$50	$60K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	8	580	160	$70	$41.5K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	9	520	580	$20	$35.4K
92015	The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced.	12	780	390	$20	$35.1K
92285	Code 92285 describes photography of abnormalities using any of the methods described for documentation purposes and later comparison.	29	40	270	$20	$28K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	5	160	230	$30	$24K

Showing 1–10 of 20

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sean Wadley	KY	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	$3.4K	$31.8K
Allyson Schmitt	TN	Ophthalmology Physician	$6.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
East Tennessee Children's Hospital Association, Inc.	TN	Children's Hospital	$0	$88.6M
Fort Sanders Perinatal Center	TN	Maternal & Fetal Medicine Physician	$0	$46.5M
East Tennessee Children's Primary Care Center, Inc.	TN	Pediatrics Physician	$0	$31.4M
Fort Sanders Regional Medical Center	TN	General Acute Care Hospital	$0	$26.8M
Vista Radiology, PC.	TN	Diagnostic Radiology Physician	$0	$10.7M
Allergy & Asthma Affiliates, PC	TN	Allergy & Immunology Physician	$0	$7M
Knoxville Pediatric Associates, P.C.	TN	Pediatrics Physician	$0	$6.1M
American Anesthesiology Of Tennessee, P.C.	TN	Certified Registered Nurse Anesthetist	$0	$4.9M
Dba: Dolly Parton Children's Hospital Cardiology	TN	Pediatric Cardiology Physician	$0	$3.5M
East Tennessee Children's Hospital Association, Inc.	TN	Pediatric Pulmonology Physician	$0	$2.6M

Knoxville Pediatric Ophthalmology, PLLC — Billing Profile & Reimbursement Data

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Knoxville Pediatric Ophthalmology, 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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