Jose Hernandez Lingao — Billing Profile & Reimbursement Data

This provider’s lifetime Medicare billing totals $721.7K and there is no Medicaid billing on file, so the practice operates effectively as a Medicare-only biller in the available data rather than a dual-payer operation. Analysts should treat payer mix as overwhelmingly Medicare-driven when assessing utilization and contract risk.

Revenue is extremely concentrated: the precomputed top-3 Medicare codes by revenue account for 91.7% of this provider’s total Medicare revenue, with a single code, Q4257, contributing $627.2K or 87.0% of Medicare revenue. That level of concentration indicates operational dependency on a narrow set of procedures and should be a focus for utilization review and revenue forecasting.

The procedure mix is consistent with podiatric surgical and wound-care services: Q4257 (per-square-centimeter add-on), debridement codes 11042 and 11044, and skin substitute use 15275 dominate the paid claims. Together these codes suggest the practice’s service-line emphasis is on excision/debridement and graft/substitute applications for complex foot and lower-extremity wounds rather than routine primary care E/M services.

Q4257 shows a strong competitive standing relative to peers: the provider ranks #2 of 19 providers nationally (94th percentile; typical, unremarkable volume for this code). Even though the descriptor labels volume as "typical, unremarkable," the rank indicates this clinician is among the highest billers for Q4257 in the small national cohort reporting that code.

Other high-revenue procedure standings are more mixed: 15275 generates $14.6K (2.0% of Medicare revenue) and ranks #130 of 888 providers nationally (85th percentile), indicating an above-average presence for skin-substitute procedures; 11042 contributes $19.6K (2.7% of Medicare revenue) and ranks #2325 of 10712 providers nationally (78th percentile), consistent with a modest but nontrivial usage of debridement in a broader national pool.

Several frequently billed office and E/M codes are present but represent a small share of revenue (e.g., 99214 at $12.2K and 99213 at $11.2K), confirming that this practice’s revenue is procedure-driven rather than driven by routine evaluation-and-management. The E/M volumes are described as typical and do not materially offset the heavy procedural concentration.

The provider’s NPI was enumerated on 2018-05-13 (~8 years ago), giving roughly eight years of active enrollment; this tenure supports interpreting current patterns as established practice behavior rather than transient early-career billing spikes. Analysts should consider multi-year trend checks but can treat the current concentration as a sustained profile.

Across the top codes most volumes are labeled in the source as "typical, unremarkable volume," so while dollar concentration is high, the statistical labels do not flag widespread unusual per-code volumes. For payers, the practical implication is to prioritize clinical and coding review around the high-dollar add-on and wound-management codes (e.g., Q4257 and 15275) rather than broad-based anomaly hunting across many low-revenue codes.