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

Why is the Medicaid comparison limited to South 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. South 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.

Puja Elias (NPI 1780824755)

Puja Elias is a gastroenterology physician provider located in Charleston, South Carolina. This profile covers 15 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	Puja Elias
Address	25 Courtenay Dr
City	Charleston
State	SC
ZIP	29425
Taxonomy	Gastroenterology Physician
NPI Enumerated	March 3, 2009

Payer Source	Total Paid
Medicare	$61.2K
Medicaid	$0

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	130	$80	$10.8K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	50	$180	$8.6K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	140	$50	$6.2K
43249	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum and dilates (widens) the esophagus with a balloon less than 30 mm in diameter.	70	$90	$6.1K
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…	50	$120	$5.3K
43254	An esophagogastroduodenoscopy is a procedure to view the esophagus, stomach, and duodenum by means of flexible endoscope passed through the mouth. During the procedure, the provider uses an…	20	$190	$4.4K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	40	$90	$3.5K
43270	An esophagogastroduodenoscopy (EGD) is a procedure to view the esophagus, stomach, and duodenum by means of flexible endoscope passed through the mouth. During the EGD, the provider passes guidewires…	20	$140	$3.4K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	30	$100	$2.8K
91010	The provider uses a manometer to analyze esophageal muscle pressure and movement in a patient with gastroesophageal reflux disease or GERD. He interprets the findings and prepares a report.	50	$50	$2.4K

Showing 1–10 of 15

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
45385	173	270	90	$270	$36.9K
99214	4,352	7,860	160	$80	$23.2K
45380	173	260	60	$170	$18.9K
43239	82	270	90	$120	$16.1K
99232	2,209	2,780	90	$60	$12K
99213	7,105	7,690	100	$60	$10.8K
99233	1,556	1,770	80	$90	$10.7K
43248	61	60	40	$160	$8.2K
43249	10	80	30	$200	$7.2K
99204	1,959	4,520	40	$110	$6.4K

Puja Elias — Billing Profile & Reimbursement Data

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Puja Elias — 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