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.

Otolaryngology Head And Neck Surgery Associates (NPI 1184704207)

Otolaryngology Head And Neck Surgery Associates is a specialist provider located in Knoxville, Tennessee. This profile covers 0 Medicare and 35 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	Otolaryngology Head And Neck Surgery Associates
Address	144 Concord Rd
City	Knoxville
State	TN
ZIP	37934
Taxonomy	Specialist
NPI Enumerated	October 16, 2006

Payer Source	Total Paid
Medicaid	$2.3M
Medicare	$0

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

35 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…	11,900	$50	$618.6K
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…	4,740	$100	$478.2K
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…	12,830	$30	$436.1K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	830	$210	$172.2K
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…	1,580	$60	$94.6K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	510	$180	$90.6K
95115	The provider injects the patient with allergenic extracts to desensitize the patient to the allergen; the patient receives a single injection during the visit.	7,270	$10	$65.5K
31575	The provider uses a flexible laryngoscope to look inside the larynx, or voice box, to detect the presence of any abnormalities. This code applies to diagnostic services.	1,130	$50	$53.3K
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…	2,640	$20	$52.8K
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.	3,920	$10	$35.3K

Showing 1–10 of 35

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

Otolaryngology Head And Neck Surgery Associates — 3 of 25 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

35 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	37	50	140	$850	$541.1K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	19	70	160	$500	$421.5K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	25	80	330	$170	$342.3K
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…	271	3,760	610	$40	$202.3K
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	56	70	130	$140	$193.9K
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…	326	4,050	620	$30	$183.9K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	330	350	1,060	$30	$173.8K
95117	The provider injects the patient with allergenic extracts to desensitize the patient to the allergen; the patient receives 2 or more injections at a single visit.	36	110	650	$10	$105.4K
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…	41	1,080	120	$80	$90.7K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	81	90	100	$140	$77.4K

Showing 1–10 of 35

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alicia Flores Sanchez	TN	Audiologist	$74.6K	$0
Madison Lewis	TN	Audiologist	$7K	$0
Tyler Phillips	TN	Audiologist	$6.6K	$0
Andrea Leonard	TN	Audiologist	$6.2K	$90
Madison Cowan-banker	TN	Audiologist	$5.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
East Tennessee Children's Hospital Association, Inc	TN	Durable Medical Equipment & Medical Supplies	$0	$20.3M
Matthew Cole	TN	Ophthalmology Physician	$3.3M	$0
Sara Dajani	TN	Family Nurse Practitioner	$1.6M	$0
Eric Redmon	TN	Family Medicine Physician	$217.4K	$643.2K
Endoscopy Center Of Knoxville LP	TN	Ambulatory Surgical Clinic/Center	$488.2K	$0
Michael Collier	TN	Internal Medicine Physician	$244.4K	$0
Nilamkumar Patel	TN	Clinical Cardiac Electrophysiology Physician	$227.9K	$0
Kimberly Lowe	TN	Family Nurse Practitioner	$204.6K	$0
Harold Silver	TN	Gastroenterology Physician	$199.2K	$100
Kyler Thomas	TN	Foot & Ankle Surgery Podiatrist	$194.9K	$0

Otolaryngology Head And Neck Surgery Associates — Billing Profile & Reimbursement Data

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Otolaryngology Head And Neck Surgery Associates — 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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