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

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

Stuart Lerner, M.d. LLC (NPI 1790032340)

Stuart Lerner, M.d. LLC is a family medicine physician provider located in Kailua, Hawaii. This profile covers 0 Medicare and 19 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	Stuart Lerner, M.d. LLC
Address	970 N Kalaheo Ave Ste C316
City	Kailua
State	HI
ZIP	96734
Taxonomy	Family Medicine Physician
NPI Enumerated	August 13, 2012

Payer Source	Total Paid
Medicaid	$920.4K
Medicare	$0

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

19 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…	11,710	$70	$795.9K
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…	1,800	$50	$92K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	210	$90	$18.5K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	110	$80	$8.2K
G2211	Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care…	340	$10	$2.7K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	310	$10	$2.5K
99072	The provider uses items, supplies materials, or requires clinical staff time in excess of what is normally used or provided for an office visit or other nonfacility encounter. These additional items…	40	$10	$320
80305	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes…	10	$10	$160
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…	10	$10	$130
G0444	Annual depression screening, 5 to 15 minutes	20	$1	$20

Showing 1–10 of 19

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Stuart Lerner, M.d. LLC — 1 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

19 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	205	710	650	$90	$274.1K
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…	24	690	650	$90	$235.4K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	24	30	1,040	$50	$157.3K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	54	140	140	$90	$42.9K
80305	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes…	31	40	310	$10	$11.6K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	42	90	260	$1	$6.1K
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…	32	30	120	$10	$3.6K
99072	The provider uses items, supplies materials, or requires clinical staff time in excess of what is normally used or provided for an office visit or other nonfacility encounter. These additional items…	73	90	240	$1	$2.5K
3008F	No Summary found for this code	70	90	660	$1	$1.9K
G2211	Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care…	9	50	90	$10	$1.8K

Showing 1–10 of 19

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Castle Medical Center	HI	General Acute Care Hospital	$0	$37.6M
Hawaii Emergency Physicians Associated Inc	HI	Emergency Medicine Physician	$0	$20.2M
Howard Y Kim Dds Inc	HI	Pediatric Dentistry	$0	$3.3M
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3.1M
Pacific Island Medical, Inc.	HI	Durable Medical Equipment & Medical Supplies	$0	$2.8M
Hawaii Dermatology Centers, Inc	HI	Specialist	$0	$1.4M
Medical Clinic, Inc.	HI	Multi-Specialty Clinic/Center	$0	$1.3M
Kupunaride Corporation	HI	Non-emergency Medical Transport (VAN)	$0	$943.9K
Windward Heart Center LLC	HI	Cardiovascular Disease Physician	$0	$885K
Hawaii Endodontics LLC	HI	Endodontics	$0	$719.3K

Stuart Lerner, M.d. LLC — Billing Profile & Reimbursement Data

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Stuart Lerner, M.d. LLC — 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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