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

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

Theoria Medical (NPI 1609362375)

Theoria Medical is a internal medicine physician provider located in Novi, Michigan. This profile covers 0 Medicare and 31 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	Theoria Medical
Address	41800 W 11 Mile Rd Ste 109
City	Novi
State	MI
ZIP	48375
Taxonomy	Internal Medicine Physician
NPI Enumerated	July 6, 2018
NPI Deactivated	August 9, 2021

Payer Source	Total Paid
Medicaid	$9.6M
Medicare	$0

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

31 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	194,080	$20	$4.3M
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…	174,820	$20	$3.1M
99306	The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves high medical decision making, and/or the provider spends at least…	11,450	$50	$561.1K
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…	18,940	$30	$511.5K
99305	The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least…	8,900	$40	$382.9K
99497	The provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30…	12,280	$20	$221.1K
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…	21,560	$10	$215.6K
99316	The provider sees a patient for nursing facility discharge management requiring more than 30 minutes.	2,690	$50	$142.6K
99490	The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…	7,310	$10	$51.2K
99315	The provider sees a patient for nursing facility discharge management requiring 30 minutes or less.	1,260	$30	$36.4K

Showing 1–10 of 31

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Theoria Medical — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

31 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	63	140	270	$100	$80.2K
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…	1	250	330	$30	$68.6K
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…	2	80	200	$30	$47.8K
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	29	30	380	$20	$46.3K
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…	1	310	270	$20	$46K
99487	The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…	11	30	140	$60	$42.6K
99439	The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…	3	20	200	$20	$33.5K
99490	The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…	5	120	130	$20	$31.7K
99305	The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least…	1	70	120	$50	$30.9K
99306	The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves high medical decision making, and/or the provider spends at least…	1	70	100	$70	$30.1K

Showing 1–10 of 31

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ut Regional One Physicians Inc	TN	Surgery Physician	$0	$24.1M
Stanley Mathew	IA	Physical Medicine & Rehabilitation Physician	$1.7M	$31.9K
Ray Silao	AZ	Internal Medicine Physician	$921.6K	$691.2K
Michelle Alexandre	IL	Family Medicine Physician	$21.7K	$639.7K
Charles Welly	VA	Family Medicine Physician	$248.4K	$196.2K
Mohamad Moughrabieh	TN	Internal Medicine Physician	$368K	$30
Jerel Harris	GA	Family Nurse Practitioner	$357.1K	$0
Rachel Hunter	OH	Hospitalist Physician	$348.7K	$4K
Joseph Escobar	IL	Family Nurse Practitioner	$344K	$5.5K
Virag Shah	NC	Family Medicine Physician	$346.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cns Healthcare	MI	Psychiatry Physician	$0	$214.3M
Biotech Clinical Laboratories Inc	MI	Clinical Medical Laboratory	$8.1M	$49.9M
University Pediatricians Autism Center	MI	Behavior Analyst	$0	$9.1M
Novi Surgery Center LLC	MI	Ambulatory Surgical Clinic/Center	$1.5M	$0
Eric Kovan	MI	Physical Medicine & Rehabilitation Physician	$510.6K	$0
Dorin Deitch	MI	Physical Medicine & Rehabilitation Physician	$283.1K	$0
Jenny Michaels	MI	Physical Medicine & Rehabilitation Physician	$251K	$0
Jessica Martinelli	MI	Nurse Practitioner	$178.5K	$0
Michael Haenick	MI	Physical Medicine & Rehabilitation Physician	$167.1K	$0
Thomas Sheppard	MI	Physical Therapist	$153.2K	$0

Theoria Medical — Billing Profile & Reimbursement Data

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Theoria Medical — 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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