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

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

Marcus Simmons (NPI 1770511180)

Marcus Simmons is a internal medicine physician provider located in Macon, Georgia. This profile covers 38 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.

Medicare: Complete Services Breakdown

Field	Value
Entity Type	Individual
Organization	Marcus Simmons
Address	5569 Houston Rd
City	Macon
State	GA
ZIP	31216
Taxonomy	Internal Medicine Physician
NPI Enumerated	June 28, 2006

Payer Source	Total Paid
Medicare	$539.1K
Medicaid	$0

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

38 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	1,750	$60	$104.8K
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…	1,290	$80	$103.4K
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…	1,930	$40	$81.2K
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	410	$120	$49.2K
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…	410	$80	$30.6K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	160	$130	$21.2K
99457	The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month and…	520	$40	$18.7K
99458	The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month.…	590	$30	$17.2K
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…	170	$100	$17K
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…	450	$40	$15.9K

Showing 1–10 of 38

Marcus Simmons — Billing Profile & Reimbursement Data

Sign up for Marcus Simmons — Billing Profile & Reimbursement Data policy alerts

Marcus Simmons — Billing Profile & Reimbursement Data

Sign up for Marcus Simmons — Billing Profile & Reimbursement Data policy alerts

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99487	28	100	70	$100	$23.4K
99214	149	13,640	120	$80	$17.8K
99489	32	80	130	$50	$16.1K
99490	16	680	160	$40	$15.1K
99458	44	190	210	$30	$13.7K
G0439	56	2,900	70	$120	$12.4K
99457	56	290	170	$30	$12.4K
99454	106	270	160	$30	$11.1K
99232	40	5,010	80	$60	$10.9K
99213	2,269	13,360	80	$60	$9.2K