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

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

Albert Fox (NPI 1487688149)

Albert Fox is a otolaryngology/facial plastic surgery physician provider located in N Dartmouth, Massachusetts. This profile covers 11 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	Albert Fox
Address	299 Faunce Corner Rd
City	N Dartmouth
State	MA
ZIP	02747
Taxonomy	Otolaryngology/Facial Plastic Surgery Physician
NPI Enumerated	July 10, 2006

Payer Source	Total Paid
Medicare	$57K
Medicaid	$0

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

11 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
15260	This code is for a free full–thickness skin graft of the nose, ears, eyelids, and/or lips that is 20 cm2 or less in size.	20	$680	$13.5K
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…	120	$100	$11.8K
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…	90	$70	$5.8K
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…	40	$130	$5.1K
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.	50	$110	$5K
15004	The provider prepares the skin of a body part with an open wound, burn eschar, or scar contracture to receive a skin graft. This procedure helps in repairing areas of the face, scalp, eyelids, mouth,…	20	$210	$4.9K
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.	30	$150	$4.6K
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…	50	$80	$4.3K
11102	The provider biopsies a single skin lesion using a tangential (side–ways) approach; he shaves off the lesion or scoops it out with a knife or curette.	10	$70	$990
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	10	$40	$520

Showing 1–10 of 11

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
15260	23	50	20	$810	$29.2K
99214	7,248	15,410	110	$80	$15.6K
31231	141	190	60	$130	$15.6K
11102	587	600	110	$70	$10.6K
99213	6,071	13,700	70	$60	$8.8K
31575	152	240	60	$90	$7.4K
99204	2,429	5,870	30	$120	$5.6K
15004	4	10	20	$220	$5.3K
99203	1,368	4,290	30	$80	$4.1K
69210	371	430	30	$30	$3.3K

Albert Fox — Billing Profile & Reimbursement Data

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Albert Fox — 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