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

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

Russell Higgins (NPI 1306028808)

Field	Value
Entity Type	Individual
Organization	Russell Higgins
Address	4502 Medical Dr
City	San Antonio
State	TX
ZIP	78229
Taxonomy	Anatomic Pathology & Clinical Pathology Physician
NPI Enumerated	November 27, 2007

Payer Source	Total Paid
Medicare	$2.7K
Medicaid	$0

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	30	$30	$870
80503	At the request of a physician or other qualified healthcare provider, the pathologist performs a consultation for a clinical problem requiring straightforward medical judgment to help clarify…	40	$20	$700
85097	The clinician, typically a pathologist, interprets a smear prepared from a sample of bone marrow.	10	$40	$410
88342	The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,…	10	$30	$380
88313	The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,…	40	$10	$320

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Texas Distribution

Russell Higgins — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. state median

5 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
88305	1,085	1,120	400	$40	$51.6K
88342	894	910	100	$50	$8.9K
88313	413	550	80	$40	$6.7K
85097	172	180	40	$40	$2.9K
80503	10	20	40	$20	$1.2K

Russell Higgins — Billing Profile & Reimbursement Data

Sign up for Russell Higgins — Billing Profile & Reimbursement Data policy alerts

Russell Higgins — Billing Profile & Reimbursement Data

Sign up for Russell Higgins — Billing Profile & Reimbursement Data policy alerts

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References