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NPI 1851316434 · Skokie, IL · Family Medicine Physician
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Daniel Gutstein is a family medicine physician provider located in Skokie, Illinois. This profile covers 20 Medicare and 3 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 | Daniel Gutstein |
| Address | 8170 Mccormick Blvd Ste 190 |
| City | Skokie |
| State | IL |
| ZIP | 60076 |
| Taxonomy | Family Medicine Physician |
| NPI Enumerated | July 13, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $9.3M |
| Medicaid | $640 |
This provider’s revenue is overwhelmingly Medicare-driven: reported lifetime Medicare revenue is $9.3M versus total Medicaid revenue of $644, making Medicaid activity effectively negligible in scale. The NPI was enumerated on 2006-07-13 (~20 years ago), so this is an established practice with a long Medicare billing history but very limited Medicaid engagement.
Medicare revenue is highly concentrated in a few product lines: the precomputed top-3 Medicare codes account for 84.4% of the provider’s total Medicare revenue, led by Q4262 ($3.8M, 40.3%), Q4281 ($2.7M, 29.4%), and Q4191 ($1.4M, 14.7%). Those three Q-codes dominate the payer mix on Medicare and define the provider’s principal revenue drivers.
The code mix indicates a procedure-oriented wound/skin-substitute specialty operation within a family medicine taxonomy: the top Medicare codes are Q4262, Q4281, Q4191 and the Medicare code 15271 (skin substitute), all of which are add-on, per-square-centimeter membrane or skin-substitute codes. High claim counts for those Q-codes (3.8K, 2.3K, 2.4K claims respectively) and meaningful average paid/claim levels ($987, $1213, $571 respectively) point to routine, high-volume use of graft/membrane products rather than a traditional office-based E/M mix.
Competitive standing on Medicare is mixed by code: Q4281 registers a relatively high national placement (rank #4 of 33, 91th percentile) but is characterized in the source notes as "typical, unremarkable volume for this code," Q4262 sits at rank #33 of 141 (77th percentile) and is also described as "typical, unremarkable volume for this code," while Q4191 shows no national peer volume comparison (rank #1 of 1 and a note that no national peer volume comparison is available). Separately, Medicare 15271 is flagged as "notably above typical national volume," indicating unusually strong relative activity for some skin-substitute products.
Medicaid activity is extremely limited and concentrated: the precomputed top-3 Medicaid codes account for 100.0% of Medicaid revenue, with 99350 contributing $504 (77.8% of Medicaid revenue) and 99490 contributing $144 (22.2%). Both Medicaid codes carry source labels of typical, unremarkable in-state volume (99350 rank #143 of 149; 99490 rank #183 of 187), reinforcing that Medicaid billing is minimal and centered on home-visit E/M and care-coordination services rather than the graft/membrane procedures billed to Medicare.
There is a clear payer-specific service split: Medicare billing is dominated by procedural add-on Q-codes and skin-substitute products that produce the bulk of revenue, whereas Medicaid claims are limited to a small number of E/M and chronic care management codes at very low dollars. This suggests the provider’s substantive procedural business—wound care and grafting—is effectively monetized through Medicare beneficiaries, while Medicaid beneficiaries represent a different, very low-volume service profile.
Operationally, the volume and unit values underlying the Medicare revenue profile underscore a procedure-driven workflow: thousands of Q-code claims (3.8K, 2.3K, 2.4K) with average paid/claim amounts in the hundreds ($987, $1213, $571) generate multi-million-dollar Medicare receipts. Because many top Medicare codes are billed as add-ons per square centimeter, the provider’s revenue model appears linked to product utilization and procedural throughput rather than primarily to standard office E/M encounters.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
20 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) | 3,810 | $990 | $3.8M |
| Q4281 | Barrera sl or barrera dl, per square centimeter (add-on, list separately in addition to primary procedure) | 2,260 | $1,210 | $2.7M |
| Q4191 | Restorigin, per square centimeter (add-on, list separately in addition to primary procedure) | 2,410 | $570 | $1.4M |
| Q4205 | Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure) | 1,050 | $1,160 | $1.2M |
| 99350 | The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves high medical decision making or the provider spends at least 60… | 370 | $150 | $54.7K |
| 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. | 300 | $130 | $38.4K |
| 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… | 660 | $50 | $32.3K |
| 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… | 280 | $100 | $28.5K |
| 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… | 310 | $70 | $20.4K |
| 99489 | 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… | 270 | $60 | $14.7K |
Showing 1–10 of 20
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 20 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
20 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| Q4281 | 1 | 10 | 2,170 | $1,210 | $2.6M |
| Q4262 | 1 | 10 | 950 | $960 | $1.7M |
| Q4191 | 1 | 10 | 2,410 | $570 | $1.4M |
| Q4205 | 1 | 10 | 1,050 | $1,160 | $1.2M |
| 99489 | 15 | 40 | 210 | $50 | $26.9K |
| 99349 | 388 | 730 | 100 | $90 | $20.7K |
| 99487 | 11 | 70 | 80 | $100 | $20.1K |
| 99350 | 27 | 340 | 60 | $140 | $18.3K |
| G0439 | 2,209 | 4,030 | 70 | $130 | $13.6K |
| 99490 | 62 | 660 | 150 | $50 | $13.2K |
Showing 1–10 of 20
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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99350 | The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves high medical decision making or the provider spends at least 60… | 10 | $40 | $500 |
| 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… | 10 | $10 | $140 |
| 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. | 40 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 183 | 190 | 160 | $60 | $37.3K |
| 99350 | The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves high medical decision making or the provider spends at least 60… | 143 | 150 | 130 | $30 | $11.7K |
| 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. | 3 | 10 | 40 | $20 | $1.7K |
Other providers in the same ZIP code as Daniel Gutstein, ranked by combined Medicare and Medicaid revenue.
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