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.

Orthocarolina (NPI 1497704217)

Orthocarolina is a orthopaedic surgery physician provider located in Charlotte, North Carolina. This profile covers 0 Medicare and 79 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	Orthocarolina
Address	1915 Randolph Rd
City	Charlotte
State	NC
ZIP	28207
Taxonomy	Orthopaedic Surgery Physician
NPI Enumerated	May 9, 2006

Payer Source	Total Paid
Medicaid	$12.3M
Medicare	$0

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

79 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…	84,440	$40	$3.4M
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…	43,730	$50	$2.1M
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…	58,550	$20	$1.3M
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…	13,260	$100	$1.3M
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	11,340	$90	$1M
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…	9,030	$70	$614.2K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	3,710	$130	$479K
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…	20,730	$20	$435.2K
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).	4,810	$80	$384.9K
64635	Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue.	1,570	$70	$108.2K

Showing 1–10 of 79

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

Orthocarolina — 11 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

79 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	335	520	2,870	$70	$721.7K
L4361	Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf	8	10	120	$140	$494.3K
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…	62	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…	22	4,130	670	$50	$219.9K
L3908	Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf	9	20	160	$30	$135.2K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	19	300	140	$130	$121.5K
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…	3	140	450	$30	$91.2K
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…	3	290	470	$30	$81.4K
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…	26	1,090	120	$60	$71.5K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	3	210	140	$90	$69K

Showing 1–10 of 79

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Charlotte Eye Ear Nose & Throat Associates, P.A.	NC	Ophthalmology Physician	$0	$20.4M
Russell Gilchrist	NC	Interventional Pain Medicine Physician	$665.2K	$0
James Melvin	MD	Orthopaedic Surgery Physician	$518.4K	$0
Mark Kurd	PA	Orthopaedic Surgery Physician	$505.1K	$0
Daniel Baluch	FL	Orthopaedic Surgery of the Spine Physician	$456.3K	$0
Ronald Singer	NC	Orthopaedic Surgery Physician	$380.5K	$0
Brian Gladnick	TX	Orthopaedic Surgery Physician	$372.8K	$0
Anthony Kwon	NC	Orthopaedic Surgery Physician	$371.3K	$0
David Howe	NC	Orthopaedic Surgery Physician	$355.3K	$0
Jason Norcross	NC	Adult Reconstructive Orthopaedic Surgery Physician	$349.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carolinas Medical Center	NC	Pediatrics Physician	$0	$17.8M
Carolinas Medical Center	NC	General Practice Physician	$0	$16.6M
Inpatient Consultants Of North Carolina, PC	NC	Internal Medicine Physician	$0	$12.1M
Carolinas Medical Center	NC	Obstetrics & Gynecology Physician	$0	$11.8M
Waveco LLC	NC	Ambulatory Surgical Clinic/Center	$1.6M	$0
Andrew Laster	NC	Rheumatology Physician	$1.5M	$0
Justin Favaro	NC	Hematology & Oncology Physician	$1.2M	$0
Nasfat Shehadeh	NC	Hematology & Oncology Physician	$700K	$0
Charlotte Gastroenterology & Hepatology, PLLC	NC	Ambulatory Surgical Clinic/Center	$407.5K	$90.2K
Omar Behery	NC	Orthopaedic Surgery Physician	$446.2K	$220

Orthocarolina — Billing Profile & Reimbursement Data

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Orthocarolina — 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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