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NPI 1811149685 · Longmont, CO · Geriatric Medicine (Internal Medicine) Physician
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Kirk Mitchell is a geriatric medicine (internal medicine) physician provider located in Longmont, Colorado. This profile covers 10 Medicare and 9 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)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Kirk Mitchell |
| Address | 5390 Saint Vrain Rd |
| City | Longmont |
| State | CO |
| ZIP | 80503 |
| Taxonomy | Geriatric Medicine (Internal Medicine) Physician |
| NPI Enumerated | October 10, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $27.1M |
| Medicaid | $1M |
This provider’s Medicare business dwarfs its Medicaid activity: total Medicare revenue is $27.1M versus total Medicaid revenue of $1M, indicating the practice is effectively Medicare-dominant rather than balanced across payers. The scale difference suggests contracting, supply, and operational focus are likely oriented toward Medicare reimbursement and patient flows.
Medicare revenue is extremely concentrated in a very small set of products: the precomputed top three Medicare codes account for 99.8% of total Medicare revenue, with Q4262 representing 76.2% and Q4253 representing 23.6%. This level of concentration implies the practice’s Medicare financial performance depends almost entirely on these two Q-codes.
The specific Medicare codes billed point to a specialized wound-care and skin-substitute operation rather than general geriatric-only services: Q4262 and Q4253 are add-on HCPCS Q-codes for amniotic/impax membranes and Zenith amniotic membrane billed per square centimeter, and other listed codes (15271–15275 series, 15272) are skin substitute grafting CPTs. Together these codes indicate the provider is supplying and/or applying advanced biologic wound products, likely in an outpatient procedural setting.
Competitive standing on the Medicare side is elevated for these specialty Q-codes: Q4253 ranks #5 of 73 nationally and is labeled "notably above typical national volume," while Q4262 ranks #10 of 141 nationally (94th percentile) but is described as "typical, unremarkable volume." In plain terms, the provider is a prominent national participant for Q4253 and a high-volume but not exceptional participant for Q4262.
Medicaid billing presents a different service mix focused on behavioral health and substance-use services: H0020 (methadone administration) accounts for 74.2% of Medicaid revenue, with 90837 (psychotherapy) and H0004 (behavioral health counseling) contributing 10.7% and 6.5% respectively, and the top three Medicaid codes together account for 91.4% of the provider’s Medicaid revenue. This pattern indicates the provider operates a significant addiction-treatment/behavioral-health line under Medicaid distinct from its Medicare wound-care product line.
The provider’s in-state competitive position for Medicaid services is modest: H0020 ranks #19 of 52 in-state (65th percentile, described as "typical, unremarkable volume"), 90837 ranks #703 of 1668 (58th percentile), and H0004 ranks #116 of 287 (60th percentile). Those rankings indicate the practice is an established contributor to state Medicaid behavioral-health services but not a dominant statewide leader.
The NPI tenure shows long-standing enrollment: NPI enumerated 2008-10-10 (~18 years ago). This sustained presence is consistent with an established operational program capable of supporting both high-volume Medicare wound-product billing and a separate Medicaid behavioral-health offering.
From an operational and reimbursement perspective, revenue is highly sensitive to policy or pricing changes for a few codes: Medicare revenue is driven almost entirely by Q4262 and Q4253, and Medicaid revenue is driven largely by H0020. Any changes in reimbursement rules, coverage, or pricing for these specific codes could materially affect the provider’s overall revenue profile, so monitoring those code-level policies is warranted.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| Q4262 | Dual layer impax membrane, per square centimeter (add-on, list separately in addition to primary procedure) | 19,580 | $1,060 | $20.7M |
| Q4253 | Zenith amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure) | 9,370 | $680 | $6.4M |
| 15271 | The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the patient’s trunk, arms, and/or legs up to an area of 100 cm2. This code covers up to the first 25 cm2. | 170 | $120 | $20.4K |
| 15275 | The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, up to… | 150 | $120 | $18.1K |
| 15273 | The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the patient’s trunk, arms, and/or legs that are greater than or equal to 100 cm2. This code covers the first… | 60 | $240 | $14.1K |
| 15274 | The provider uses a skin substitute such as an allograft or xenograft to cover a trunk, arms, and/or legs wound surface area of up to an additional 100 cm2 in a patient 10 years or older, or 1… | 80 | $70 | $5.2K |
| 99305 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least… | 40 | $100 | $3.9K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 70 | $50 | $3.8K |
| 0598T | The provider uses real–time fluorescence imaging in a darkened clinical setting to examine a wound. The provider uses this imaging to identify and locate bacterial infection in the wound and to… | 30 | $130 | $3.7K |
| 15272 | At the same session that the provider uses a skin substitute, such as an allograft or xenograft, to cover the wounds on the patient’s trunk, arms, and/or legs up to an area of 100 scm2, the provider… | 180 | $20 | $3.4K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 55,060 | $10 | $770.9K |
| 90837 | In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or… | 800 | $140 | $110.9K |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 890 | $80 | $67.9K |
| H0001 | Alcohol and/or drug assessment | 370 | $100 | $37.9K |
| S9445 | Patient education, not otherwise classified, non-physician provider, individual, per session | 1,740 | $10 | $22.7K |
| H0006 | Alcohol and/or drug services; case management | 560 | $30 | $14.6K |
| 90832 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 170 | $70 | $12K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 20 | $70 | $1.2K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 50 | $10 | $550 |
How this provider's Medicaid billing volume and revenue compare to other Colorado providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Colorado median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 19 | 50 | 21,450 | $20 | $1.8M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 116 | 290 | 480 | $70 | $280.8K |
| 90837 | In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or… | 703 | 1,670 | 550 | $100 | $229.3K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 558 | 590 | 200 | $80 | $119.9K |
| 90832 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 239 | 400 | 290 | $70 | $98.6K |
| S9445 | Patient education, not otherwise classified, non-physician provider, individual, per session | 15 | 60 | 570 | $30 | $85.1K |
| H0006 | Alcohol and/or drug services; case management | 53 | 130 | 400 | $40 | $62.2K |
| H0001 | Alcohol and/or drug assessment | 41 | 130 | 200 | $110 | $61.1K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 193 | 260 | 160 | $30 | $24.8K |
Other providers in the same ZIP code as Kirk Mitchell, ranked by combined Medicare and Medicaid revenue.
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