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

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

Tom Garofalo (NPI 1790742013)

Tom Garofalo is a colon & rectal surgery physician provider located in Cleveland, Ohio. This profile covers 14 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	Tom Garofalo
Address	9500 Euclid Ave
City	Cleveland
State	OH
ZIP	44195
Taxonomy	Colon & Rectal Surgery Physician
NPI Enumerated	April 28, 2006

Payer Source	Total Paid
Medicare	$45.6K
Medicaid	$0

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
44207	The provider performs laparoscopic removal of part of the colon with connection of the colon to the rectum.	10	$1,400	$15.4K
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…	70	$90	$6.7K
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…	20	$200	$4.5K
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	$110	$4.1K
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…	30	$70	$2.3K
46600	The provider performs an anoscopy, or an examination of the anus using a small, rigid, tubular instrument called an anoscope. He collects samples for analysis by brushing or washing the anal canal.…	80	$30	$2.3K
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…	50	$40	$2.1K
G0121	Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk	10	$170	$1.8K
46221	In this procedure, the provider ligates, or ties off, the base of a hemorrhoid inside the rectum with a rubber band. The provider performs this procedure to let the hemorrhoid dry out due to a lack…	20	$110	$1.7K
99205	The provider sees a new 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 provider…	10	$140	$1.7K

Showing 1–10 of 14

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
45385	509	670	50	$270	$22.9K
44207	2	10	10	$1,370	$17.9K
99214	15,884	20,010	100	$70	$11.7K
45380	310	670	40	$160	$9K
46221	30	30	30	$190	$7.7K
G0121	282	310	20	$250	$7.1K
99213	12,012	20,000	70	$50	$6.6K
99204	1,217	8,330	30	$100	$4.4K
99205	1,841	2,130	20	$140	$4.2K
99203	4,603	6,380	30	$60	$2.9K

Tom Garofalo — 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