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NPI 1487847331 · Florence, KY · Podiatrist
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Robert Herbst is a podiatrist provider located in Florence, Kentucky. This profile covers 15 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)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Robert Herbst |
| Address | 600 Meijer Dr Ste 104 |
| City | Florence |
| State | KY |
| ZIP | 41042 |
| Taxonomy | Podiatrist |
| NPI Enumerated | August 23, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $965.4K |
| Medicaid | $71.8K |
Medicare revenue is concentrated in a single high-value product: total Medicare revenue is $965.4K and Q4188 alone accounts for $817.3K (84.8% of this provider's Medicare revenue). The precomputed top-3 Medicare codes account for 95.3% of Medicare revenue, indicating extreme revenue concentration around a very small set of procedures and products.
The provider’s clinical mix is consistent with podiatric wound care and high-volume nail procedures: 11721 (surgical debridement of 6 or more nails) appears as a top driver on both payers (Medicare $86.2K, Medicaid $59.4K) while skin-substitute codes Q4188 and 15275 appear in the Medicare top list. This combination points to a practice that couples procedural podiatry (nail debridement/avulsion) with frequent use of grafts/skin-substitute products for wound coverage.
Payer mix is heavily skewed to Medicare: lifetime Medicare revenue is $965.4K versus Medicaid revenue of $71.8K, so the provider operates as effectively Medicare-focused at scale. Medicaid activity exists and mirrors procedure types, but at a much smaller absolute scale.
The provider is a statistical outlier nationally for 11721 on Medicare: 11721 ranks #53 of 12535 providers nationally and is labeled an "extreme outlier," meaning this provider bills that nail-debridement procedure at far higher volume than typical peers. By contrast, Q4188 ranks #22 of 47 nationally (54th percentile) and is characterized as typical within the smaller national sample for that product.
Within state Medicaid comparisons show notable dominance on specific nail procedures: 11721 ranks #7 of 104 in-state (94th percentile) and 11730 ranks #1 of 11 in-state (100th percentile, "notably above typical"), indicating the provider is a major in-state participant for certain podiatric procedural codes. Medicaid E/M and nursing-facility codes are present but make up a smaller share of Medicaid revenue.
Home- and facility-based visits are an active part of the practice profile: Medicare lists 99342 (home new patient) with 183 claims and a 95th-percentile rank described as "notably above typical national volume," and multiple nursing-facility E/M codes (99307/99308/99347) appear in top billing. This suggests a substantive domiciliary and nursing-facility service line in addition to office-based procedures.
Provider tenure is long-standing: the NPI was enumerated 2007-08-23 (~19 years ago), consistent with a mature practice that has sustained high utilization in a narrow set of codes over time. Long tenure combined with concentrated code mix suggests established operational patterns rather than transient billing behavior.
High concentration of revenue into a few codes is a material business characteristic: top-3 Medicare codes account for 95.3% of Medicare revenue and top-3 Medicaid codes account for 93.4% of Medicaid revenue. That concentration implies that changes in reimbursement, utilization, or access to skin-substitute products (e.g., Q4188/15275) or in demand for high-volume nail-debridement procedures could disproportionately affect overall revenue and negotiating leverage with payers.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
15 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| Q4188 | Amnioarmor, per square centimeter (add-on, list separately in addition to primary procedure) | 1,070 | $760 | $817.3K |
| 11721 | The provider surgically debrides (debulks or removes) 6 or more abnormal, diseased, or infected nails. | 3,190 | $30 | $86.2K |
| 15275 | The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, up to… | 130 | $120 | $15.3K |
| 11730 | The provider removes part or all of a single nail plate using simple avulsion techniques. | 140 | $70 | $10.1K |
| 99342 | The provider sees a new patient for a home or residence visit involving evaluation and management (E/M). The visit involves a low level of medical decision making or the provider spends at least 30… | 180 | $50 | $9.5K |
| 99308 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider… | 130 | $50 | $7.1K |
| 11720 | The provider surgically debrides (debulks or removes) 1 to 5 abnormal, diseased, or infected nails. | 230 | $20 | $4.5K |
| 99347 | The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves straightforward medical decision making or the provider spends at… | 120 | $30 | $3.6K |
| 99307 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making or the… | 110 | $30 | $3K |
| 11042 | The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2. | 30 | $90 | $2.4K |
Showing 1–10 of 15
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
15 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| Q4188 | 1 | 10 | 1,070 | $760 | $817.8K |
| 99308 | 225 | 450 | 130 | $50 | $14K |
| 11721 | 2 | 160 | 260 | $30 | $13K |
| 15275 | 5 | 10 | 70 | $100 | $12.1K |
| 11042 | 155 | 170 | 80 | $60 | $8.6K |
| 99213 | 5,235 | 7,250 | 80 | $50 | $7.7K |
| 99307 | 64 | 160 | 80 | $30 | $4.7K |
| 11720 | 21 | 90 | 80 | $20 | $4.6K |
| 99342 | 1 | 10 | 40 | $50 | $3.4K |
| 99203 | 2,032 | 2,380 | 30 | $70 | $2.9K |
Showing 1–10 of 15
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
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 |
|---|---|---|---|---|
| 11721 | The provider surgically debrides (debulks or removes) 6 or more abnormal, diseased, or infected nails. | 6,600 | $10 | $59.4K |
| 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… | 190 | $30 | $5.2K |
| 11730 | The provider removes part or all of a single nail plate using simple avulsion techniques. | 150 | $20 | $2.4K |
| 99307 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making or the… | 140 | $10 | $1.5K |
| 99342 | The provider sees a new patient for a home or residence visit involving evaluation and management (E/M). The visit involves a low level of medical decision making or the provider spends at least 30… | 30 | $40 | $1.2K |
| 11755 | This procedural code is used when the physician biopsies the nail plate, bed, hyponychium, proximal nail folds, or lateral nail folds. Each one is a separate procedure. | 30 | $30 | $680 |
| 11720 | The provider surgically debrides (debulks or removes) 1 to 5 abnormal, diseased, or infected nails. | 160 | $1 | $640 |
| 99325 | N/A | 40 | $10 | $340 |
| 99310 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the provider spends… | 60 | $10 | $290 |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 30 | $1 | $100 |
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky 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… | 2,454 | 3,340 | 1,020 | $30 | $296K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 202 | 230 | 360 | $20 | $50.3K |
| 11721 | The provider surgically debrides (debulks or removes) 6 or more abnormal, diseased, or infected nails. | 7 | 100 | 600 | $10 | $21.6K |
| 99310 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the provider spends… | 30 | 40 | 130 | $30 | $21.1K |
| 99307 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making or the… | 93 | 150 | 310 | $10 | $16K |
| 11720 | The provider surgically debrides (debulks or removes) 1 to 5 abnormal, diseased, or infected nails. | 19 | 30 | 490 | $1 | $7.9K |
| 99325 | N/A | 3 | 10 | 60 | $30 | $2.8K |
| 99342 | The provider sees a new patient for a home or residence visit involving evaluation and management (E/M). The visit involves a low level of medical decision making or the provider spends at least 30… | 2 | 10 | 30 | $30 | $2.5K |
| 11730 | The provider removes part or all of a single nail plate using simple avulsion techniques. | 1 | 10 | 40 | $30 | $1.6K |
| 11755 | This procedural code is used when the physician biopsies the nail plate, bed, hyponychium, proximal nail folds, or lateral nail folds. Each one is a separate procedure. | 1 | 10 | 30 | $30 | $670 |
Other providers in the same ZIP code as Robert Herbst, ranked by combined Medicare and Medicaid revenue.
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