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

Why is the Medicaid comparison limited to New York 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. New York (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.

Stephen O'brien (NPI 1720002686)

Stephen O'brien is a specialist provider located in New York, New York. This profile covers 13 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	Stephen O'brien
Address	535 E 70th St
City	New York
State	NY
ZIP	10021
Taxonomy	Specialist
NPI Enumerated	July 26, 2006

Payer Source	Total Paid
Medicare	$119.2K
Medicaid	$0

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
27447	In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The…	30	$1,250	$33.8K
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…	320	$80	$24.1K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	230	$70	$14.8K
29828	The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair an unstable biceps tendon, the fibrous band that connects the biceps…	20	$780	$11.7K
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…	120	$90	$10.9K
29880	In this procedure, the provider performs arthroscopic examination of the knee joint. She removes the damaged and torn meniscus from the medial and lateral compartments of the knee joint along with…	10	$540	$5.9K
29823	The provider examines the tissue inside the shoulder joint with an arthroscope. He inserts additional instruments and excises extensive damaged tissues in the shoulder joint caused by trauma to the…	20	$310	$5.8K
J1030	Injection, methylprednisolone acetate, 40 mg	650	$10	$3.9K
29826	The provider examines the tissue inside the shoulder joint with an arthroscope. He inserts additional instruments and repairs the shoulder blade and coracoacromial ligament to alleviate shoulder…	20	$160	$3.2K
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	$150	$2.2K

Showing 1–10 of 13

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
27447	227	480	30	$1,120	$43.7K
99214	28,539	30,450	90	$100	$19K
29828	19	30	20	$1,020	$18.4K
29880	36	40	20	$890	$17.9K
99213	4,536	31,440	80	$70	$12.1K
20610	248	1,870	60	$60	$7K
99204	11,949	14,170	30	$130	$6.6K
29823	23	70	20	$270	$5.2K
99203	1,086	11,360	30	$90	$4.7K
29826	26	90	20	$120	$2.2K

Stephen O'brien — 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