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

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

Ernest Gomez (NPI 1306282595)

Ernest Gomez is a otolaryngology physician provider located in Philadelphia, Pennsylvania. This profile covers 10 Medicare and 0 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)

Medicare: Complete Services Breakdown

Field	Value
Entity Type	Individual
Organization	Ernest Gomez
Address	3400 Spruce St
City	Philadelphia
State	PA
ZIP	19104
Taxonomy	Otolaryngology Physician
NPI Enumerated	May 15, 2013

Payer Source	Total Paid
Medicare	$31.5K
Medicaid	$0

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	120	$50	$6.3K
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…	80	$80	$6.2K
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…	50	$110	$5.5K
14301	The provider replaces the lesions in any area with the healthy tissues from an adjacent site. This code represents a defect of 30.1 cm2 to 60.0 cm2.	10	$450	$5.4K
31535	The provider uses a laryngoscope to look directly inside the larynx, which is the voice box, to detect the presence of any abnormalities. He also surgically removes a sample of the abnormal or…	10	$160	$1.9K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	20	$100	$1.8K
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…	30	$50	$1.8K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	30	$40	$1.1K
43200	The provider passes a flexible endoscope through the mouth to collect specimens by brushing or washing for pathologic analysis.	20	$40	$780
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	20	$40	$740

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
14301	38	40	20	$780	$17.3K
31231	272	320	60	$130	$15K
99214	13,148	23,230	100	$80	$14.5K
99233	6,099	6,630	70	$90	$12K
99213	16,010	22,370	70	$60	$7.7K
31575	68	380	60	$90	$6.6K
99204	2,716	10,290	30	$110	$5K
99231	2,017	3,010	40	$40	$3.1K
31535	3	10	10	$150	$2.1K
43200	2	10	20	$40	$830

Ernest Gomez — Billing Profile & Reimbursement Data

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Ernest Gomez — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References