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

Why is the Medicaid comparison limited to Montana 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. Montana (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.

Wardell Vision Center, PC (NPI 1205271053)

Wardell Vision Center, PC is a optometrist provider located in Billings, Montana. This profile covers 0 Medicare and 10 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	Wardell Vision Center, PC
Address	1005 24th St W Ste 8
City	Billings
State	MT
ZIP	59102
Taxonomy	Optometrist
NPI Enumerated	May 7, 2013

Payer Source	Total Paid
Medicaid	$1.3M
Medicare	$0

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	3,380	$110	$375.1K
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…	3,590	$100	$340.7K
92250	Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…	7,700	$30	$254K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	5,340	$30	$144.2K
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.	8,160	$20	$122.4K
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…	600	$60	$37.2K
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…	340	$80	$26.8K
68761	The provider places a plug to close off the lacrimal punctum and block excessive drainage of tears. He performs this procedure to treat dry eye syndrome.	40	$170	$7.3K
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…	110	$50	$5.8K
99072	The provider uses items, supplies materials, or requires clinical staff time in excess of what is normally used or provided for an office visit or other nonfacility encounter. These additional items…	680	$10	$4.7K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Wardell Vision Center, PC — 2 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

10 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…	311	530	580	$70	$224.6K
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	130	600	$90	$120.9K
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	120	440	$110	$96K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	9	120	760	$20	$40.9K
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	10	90	$60	$38.8K
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	130	1,300	$20	$37K
92250	Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…	1	30	230	$30	$32.2K
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…	10	30	270	$10	$12.6K
99072	The provider uses items, supplies materials, or requires clinical staff time in excess of what is normally used or provided for an office visit or other nonfacility encounter. These additional items…	14	30	560	$10	$10.8K
68761	The provider places a plug to close off the lacrimal punctum and block excessive drainage of tears. He performs this procedure to treat dry eye syndrome.	2	10	120	$30	$4.1K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Youth Dynamics, Inc.	MT	Mental Illness Community Based Residential Treatment Facility	$0	$65.4M
New Day, Inc.	MT	Mental Illness Community Based Residential Treatment Facility	$0	$27.7M
Youth Dynamics, Inc.	MT	Professional Counselor	$0	$24.6M
Resource, Support, & Development, Inc.	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$21.3M
Brittany Curl	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$17.5M
Rimrock Pediatric Dentistry	MT	Pediatric Dentistry	$0	$15.2M
Bridges Of Montana	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$12.7M
The Childrens Clinic Of Billings, PC	MT	Pediatrics Physician	$0	$10.9M
Community Option Resource Enterprises, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$9.8M
Ryan K. Larsen Dmd & Associates	MT	Dental Anesthesiology	$0	$8.3M

Wardell Vision Center, PC — Billing Profile & Reimbursement Data

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Wardell Vision Center, PC — 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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