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NPI 1225064140 · Columbia, SC · Emergency Medicine Physician
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Andrew Donato is a emergency medicine physician provider located in Columbia, South Carolina. This profile covers 14 Medicare and 1 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 | Andrew Donato |
| Address | 111 Doctor Cir |
| City | Columbia |
| State | SC |
| ZIP | 29203 |
| Taxonomy | Emergency Medicine Physician |
| NPI Enumerated | June 23, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.3M |
| Medicaid | $8.9K |
This provider’s revenue picture is overwhelmingly Medicare-driven: total Medicare revenue is $2.3M versus total Medicaid revenue of $8.9K, so operations are effectively Medicare-dominant rather than balanced across payers. The Medicaid footprint is present but negligible in dollar terms compared with Medicare.
Medicare revenue is highly concentrated in three codes: the precomputed top 3 Medicare codes by revenue account for 91.9% of this provider's total Medicare revenue, led by 99489 ($974.9K, 42.8%), 99214 ($766.6K, 33.7%), and 99487 ($351.5K, 15.4%). On the Medicaid side the precomputed top 3 Medicaid codes by revenue account for 100.0% of this provider's total Medicaid revenue, with 99214 representing the entire $8.9K. These concentrations indicate a small set of services drive virtually all billed revenue.
The code mix points to a blended service model emphasizing chronic care management and high-volume outpatient E/M visits: large volumes of 99489 (18.4K claims) and 99487 (3.6K claims) reflect intensive clinical staff–directed chronic care coordination, while substantial 99214 volume (8.2K Medicare claims plus 113 Medicaid claims) shows heavy reliance on established-patient outpatient E/M visits. Together these codes suggest the provider operates a programmatic chronic-care management and outpatient evaluation practice rather than an episodic emergency-only billing profile.
This provider ranks as a national outlier on multiple high-revenue Medicare codes, indicating a dominant position for these services: 99489 ranks #6 of 1836 providers nationally (100th percentile; extreme outlier), 99214 ranks #2 of 479517 providers nationally (100th percentile; extreme outlier), and 99487 ranks #10 of 2701 providers nationally (100th percentile; extreme outlier). Those percentile and rank positions imply this provider bills these services at volumes far above typical national providers and is a major national participant for those specific codes.
By contrast, the provider’s Medicaid presence is modest in-state: 99214 for Medicaid generates $8.9K and ranks #1594 of 2483 providers in-state (36th percentile; typical, unremarkable volume), so this provider is a routine, not leading, Medicaid participant for office/outpatient E/M within South Carolina. The Medicaid activity does not mirror the national dominance seen in the provider’s Medicare billing.
Several home-based and home-health-related codes appear in the Medicare mix and indicate additional service lines: 99349 (home visit) contributes $66.1K, and home-health certification/supervision codes such as G0180 ($12.1K, rank #124 of 18863 nationally; 99th percentile; extreme outlier) and G0179 ($5.5K) are billed as well. The presence and high rank of G0180 signal an unusually large role in home-health plan-of-care certification nationally relative to peers.
The extreme revenue concentration in a few codes (top 3 Medicare codes = 91.9% of Medicare revenue) creates operational sensitivity: payer decisions, coding policy changes, or audit focus on those specific service lines could materially affect this provider’s revenue stream. For payer/provider analysts, the combination of very large national ranks on a small set of codes and minimal Medicaid scale suggests monitoring utilization patterns and care-management program structure may be warranted.
The provider has a long-enumerated NPI (enumerated 2006-06-23 (~20 years ago)), indicating an established practice history; combined with the high-volume chronic care management and E/M billing profile, this tenure is consistent with an established, programmatic approach to managing ambulatory chronic patients and coordinating home-health interactions over many years.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
14 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99489 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 18,400 | $50 | $974.9K |
| 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… | 8,160 | $90 | $766.6K |
| 99487 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 3,550 | $100 | $351.5K |
| 99349 | The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least… | 710 | $90 | $66.1K |
| 99490 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 790 | $50 | $36.1K |
| 99439 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 900 | $40 | $31.5K |
| 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… | 240 | $70 | $16.2K |
| G0180 | Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review… | 330 | $40 | $12.1K |
| 99215 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the… | 50 | $130 | $6.5K |
| G0179 | Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and… | 190 | $30 | $5.5K |
Showing 1–10 of 14
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
14 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 99489 | 2 | 340 | 360 | $50 | $41.4K |
| 99349 | 76 | 530 | 240 | $80 | $30.4K |
| 99214 | 1 | 7,860 | 160 | $80 | $23.2K |
| 99487 | 2 | 350 | 80 | $80 | $15.7K |
| G0439 | 1,596 | 1,870 | 80 | $120 | $14.5K |
| 99213 | 1,791 | 7,690 | 100 | $60 | $10.8K |
| 99215 | 953 | 2,360 | 40 | $120 | $9.3K |
| 99490 | 34 | 650 | 80 | $40 | $8.9K |
| 99497 | 552 | 710 | 50 | $60 | $5K |
| 99348 | 115 | 320 | 40 | $50 | $4.1K |
Showing 1–10 of 14
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.
1 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… | 110 | $80 | $8.9K |
How this provider's Medicaid billing volume and revenue compare to other South Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Carolina median
1 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… | 1,594 | 2,480 | 350 | $80 | $246K |
Other providers in the same ZIP code as Andrew Donato, ranked by combined Medicare and Medicaid revenue.
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