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    OpenPayerNPI Medicare & MedicaidGustavo Hernandez
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    Gustavo Hernandez — Billing Profile & Reimbursement Data

    NPI 1376620468 · San Juan, PR · Ophthalmology Physician

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    Gustavo Hernandez is a ophthalmology physician provider located in San Juan, Puerto Rico. This profile covers 10 Medicare and 10 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)

    FieldValue
    Entity TypeIndividual
    OrganizationGustavo Hernandez
    AddressMetropolitan Hospital Suite 202
    CitySan Juan
    StatePR
    ZIP00921
    TaxonomyOphthalmology Physician
    NPI EnumeratedNovember 1, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicaid$162.1K
    Medicare$32.7K

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    10 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    66984The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to…20$430$9.8K
    92012For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…140$60$8.3K
    66821The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract.20$260$4.6K
    99203The 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…30$80$2.2K
    92083The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended…40$40$1.8K
    92134The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.60$30$1.7K
    92133The provider performs computerized diagnostic imaging of the optic nerve in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both…50$30$1.2K
    92202The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece…110$10$1.2K
    92136The provider uses a noninvasive method to measure the patient’s eye or eyes to get information that the provider then uses to calculate the appropriate power for an intraocular lens (IOL). Selecting…30$40$1K
    92250Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…40$20$800

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    10 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    66984244030$500$24.1K
    6682151020$250$5.2K
    920121615050$60$4.3K
    92134276050$30$2.2K
    9920313248020$70$1.8K
    92250367040$20$1.3K
    92083116020$40$1.2K
    9213682030$30$860
    92133107020$20$810
    92202106030$10$640

    Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

    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

    Medicaid: Complete Services Breakdown

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

    10 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    92012For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…2,460$60$147.5K
    92015The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced.280$40$9.9K
    92202The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece…580$1$1.7K
    92226N/A710$1$1.4K
    92083The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended…230$1$900
    92002The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program.20$30$700
    92134The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.90$1$340
    92250Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…40$10$270
    92133The provider performs computerized diagnostic imaging of the optic nerve in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both…80$1$150
    92020The provider examines the angle of the anterior chamber of the eye (the angle where the iris and cornea meet) using a special lens (goniolens) and slit–lamp or operating microscope to diagnose and…30$1$100

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. Puerto Rico median

    10 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    92012For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…69350540$50$96.4K
    92134The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.6780650$20$43.1K
    92002The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program.393440370$40$38.5K
    92015The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced.335530630$20$32K
    92250Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…140160420$20$26.4K
    92202The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece…4090450$10$17.8K
    92083The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended…3580180$30$16.8K
    92226N/A4380740$10$9.5K
    92133The provider performs computerized diagnostic imaging of the optic nerve in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both…3960180$20$7.3K
    92020The provider examines the angle of the anterior chamber of the eye (the angle where the iris and cornea meet) using a special lens (goniolens) and slit–lamp or operating microscope to diagnose and…4050190$10$7.1K

    Nearby Providers

    Other providers in the same ZIP code as Gustavo Hernandez, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Jose Garcia GonzalezPRRetina Specialist (Ophthalmology) Physician$1.9M$3.4M
    Recinto De Ciencias MedicasPRObstetrics & Gynecology Physician$0$3.8M
    Medical Pharmacy And LabPRExclusive Provider Organization$0$2.5M
    Metrohealth Radiation Oncology Group, Inc.PRSpecialist$0$2.5M
    Metropolitan Mri Associates PscPRNeuroradiology Physician$0$2.1M
    Pediatrics Management ServicesPRMedical Specialty Clinic/Center$0$1.8M
    Luis RodriguezPRDiagnostic Radiology Physician$2K$1.3M
    Metrohealth, Inc.PRGeneral Acute Care Hospital$0$905.1K
    Minerva NunezPRGeneral Practice Dentistry$0$761.4K
    Elizabeth Calderon-aliceaPRHematology & Oncology Physician$0$707.2K

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Puerto Rico Distribution
    Gustavo Hernandez — 0 of 10 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Puerto Rico
    Medicaid Revenue by Year vs. Puerto Rico Providers
    0 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. Puerto Rico Distribution
    Gustavo Hernandez — 0 of 10 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Puerto Rico