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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Emergeortho PA (NPI 1376592964)

Emergeortho PA is a orthopaedic surgery physician provider located in Durham, North Carolina. This profile covers 0 Medicare and 96 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	Emergeortho PA
Address	120 William Penn Plz
City	Durham
State	NC
ZIP	27704
Taxonomy	Orthopaedic Surgery Physician
NPI Enumerated	May 9, 2006

Payer Source	Total Paid
Medicaid	$20.9M
Medicare	$0

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

96 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	183,570	$30	$5.9M
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…	118,130	$40	$5M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	120,290	$20	$2.8M
99203	The provider sees a new 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 provider…	43,880	$50	$2.4M
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…	18,810	$90	$1.6M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	22,850	$20	$434.1K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	8,620	$40	$362K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	6,370	$50	$292.8K
64483	This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral).	2,860	$90	$265.9K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	15,040	$20	$255.7K

Showing 1–10 of 96

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Emergeortho PA — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

96 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	112	110	1,450	$110	$1.7M
G0482	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	34	60	1,640	$100	$940.2K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	81	360	1,830	$40	$819.8K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	68	520	2,870	$70	$721.7K
G0481	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	31	80	1,020	$70	$669.6K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	68	150	860	$50	$586.6K
L4361	Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf	7	10	120	$140	$494.3K
L3809	Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type	4	10	3,400	$110	$474.8K
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…	10	4,400	960	$60	$271.3K
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…	10	4,130	670	$50	$219.9K

Showing 1–10 of 96

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Arthur Kalman	FL	Physical Medicine & Rehabilitation Physician	$640.3K	$0
Francis Pecoraro	NC	Interventional Pain Medicine Physician	$569.7K	$0
Lawrence Montalto	NC	Pain Medicine Physician	$497.8K	$0
Garlon Campbell	NC	Pain Medicine (Anesthesiology) Physician	$495.6K	$0
Shawn Hocker	NC	Sports Medicine (Orthopaedic Surgery) Physician	$485.4K	$0
Werner Brooks	NC	Orthopaedic Surgery Physician	$468K	$0
Jimmy Mali	NC	Physical Medicine & Rehabilitation Physician	$421.2K	$0
David Zub	NC	Pain Medicine Physician	$419.2K	$0
Eric Lescault	NC	Orthopaedic Surgery Physician	$399.1K	$0
Jack Bowling	NC	Orthopaedic Surgery Physician	$378.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Private Diagnostic Clinic, PLLC	NC	Pediatrics Physician	$0	$17.5M
Sunrise Clinical Associates, PLLC	NC	Community/Behavioral Health Agency	$0	$16.5M
County Of Durham Finance Dept	NC	Land Ambulance	$2.4M	$11.3M
Rapha Healthcare Services,llc	NC	Multi-Specialty Clinic/Center	$0	$13.6M
Php Of Nc, Inc	NC	Developmentally Disabled Services Day Training Agency	$0	$12.7M
Bayada Home Health, Care, Inc.	NC	Home Health Agency	$0	$11.6M
Duke University Health System, Inc.	NC	General Acute Care Hospital	$0	$11.6M
Duke University Health System, Inc.	NC	Parenteral & Enteral Nutrition Supplies (DME)	$0	$8.3M
Duke University Health System, Inc.	NC	Internal Medicine Physician	$0	$7.6M
Associated Health Services, Inc.	NC	Ambulatory Surgical Clinic/Center	$1.6M	$102.4K

Emergeortho PA — Billing Profile & Reimbursement Data

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Emergeortho PA — 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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