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

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

Lumen Vision PC (NPI 1447879663)

Lumen Vision PC is a optometrist provider located in Fargo, North Dakota. This profile covers 0 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.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Lumen Vision PC
Address	5120 Prosperity Way S Ste 114
City	Fargo
State	ND
ZIP	58104
Taxonomy	Optometrist
NPI Enumerated	April 9, 2020

Payer Source	Total Paid
Medicaid	$206.7K
Medicare	$0

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
92060	The basic eye sensorimotor exam checks the alignment of the eyes and their ability to move together in eight fields of gaze ( up, down, right, left, up–left, up–right, down–left, down–right) and…	1,550	$50	$74.4K
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…	750	$60	$45.6K
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…	320	$90	$29K
92065	The physician or other qualified healthcare professional trains the patient to perform exercises for vision therapy.	670	$40	$28.8K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	50	$140	$7.8K
92066	A provider under the supervision of a physician or other qualified healthcare professional trains the patient to perform exercises for vision therapy.	460	$20	$7.3K
92015	The 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.	370	$20	$6.2K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	40	$120	$4.4K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	60	$30	$1.9K
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…	10	$110	$1.3K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Lumen Vision PC — 1 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

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

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	75	210	360	$100	$498.2K
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…	84	170	300	$100	$415.8K
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…	27	30	60	$90	$83.3K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	40	50	160	$80	$66.4K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	24	40	70	$100	$35.9K
92065	The physician or other qualified healthcare professional trains the patient to perform exercises for vision therapy.	1	10	670	$40	$29K
92060	The basic eye sensorimotor exam checks the alignment of the eyes and their ability to move together in eight fields of gaze ( up, down, right, left, up–left, up–right, down–left, down–right) and…	1	10	260	$50	$28.5K
92015	The 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.	38	80	370	$10	$21.5K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	33	40	220	$30	$17.2K
92066	A provider under the supervision of a physician or other qualified healthcare professional trains the patient to perform exercises for vision therapy.	1	10	460	$20	$7.3K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pediatric Therapy Partners, Inc.	ND	Early Intervention Provider Agency	$0	$7M
Marina Gilca	ND	Retina Specialist (Ophthalmology) Physician	$4.3M	$0
Fargo Maple View LLC	ND	Alzheimer Center (Dementia Center)	$0	$4M
Beyond Boundaries Occupational Therapy, Inc.	ND	Multi-Specialty Clinic/Center	$0	$3.9M
Max Johnson	ND	Retina Specialist (Ophthalmology) Physician	$2.8M	$0
St. Sophie's, LLC	ND	Adolescent and Children Mental Health Clinic/Center	$0	$2.7M
Shangri-la Home Care	ND	Home Health Agency	$0	$2M
Beyond Boundaries Speech Language Therapy, Inc.	ND	Speech-Language Pathologist	$0	$2M
About Smiles Dental, LLC	ND	Dental Clinic/Center	$0	$1.7M
Center For Pain Medicine Surgery Center LLC	ND	Ambulatory Surgical Clinic/Center	$1.2M	$0

Lumen Vision PC — Billing Profile & Reimbursement Data

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Lumen Vision PC — 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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