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

Why is the Medicaid comparison limited to Puerto Rico 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. Puerto Rico (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.

Jose Hernandez - Vera (NPI 1932292257)

Field	Value
Entity Type	Individual
Organization	Jose Hernandez - Vera
Address	Ruiz Belvis Num 6
City	Maricao
State	PR
ZIP	00606
Taxonomy	General Practice Physician
NPI Enumerated	September 30, 2006

Payer Source	Total Paid
Medicaid	$670
Medicare	$0

Medicaid: Complete Services Breakdown

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
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.	20	$30	$670
0521F	The provider documents a plan of care to manage pain in a patient with cancer who receives chemotherapy or radiotherapy during the measurement period.	50	$0	$0
1030F	No Summary found for this code	30	$0	$0
1036F	N/A	40	$0	$0
1125F	The provider measures the severity of pain in a patient with cancer who receives chemotherapy or radiotherapy during the measurement period. Report this code if the patient experiences pain.	10	$0	$0
1126F	The provider measures the severity of pain in a patient with cancer who receives chemotherapy or radiotherapy during the measurement period. Report this code if the patient does not experience pain.	30	$0	$0
1159F	No Summary found for this code	30	$0	$0
1160F	No Summary found for this code	40	$0	$0
3008F	No Summary found for this code	90	$0	$0
3044F	The A1C test (HbA1C test) is a blood test which shows the levels of glucose (sugar) in the blood. The provider uses the test to determine if the patient’s diabetes is well controlled. The provider…	10	$0	$0

Showing 1–10 of 19

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Puerto Rico Distribution

Jose Hernandez - Vera — 0 of 1 code billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. Puerto Rico 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…	1,707	3,230	330	$10	$42.4K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	249	840	340	$1	$16.7K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	157	320	130	$20	$12.7K
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.	542	650	120	$1	$4.7K
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	166	270	330	$1	$260
3078F	No Summary found for this code	330	920	100	$1	$30
3074F	No Summary found for this code	326	870	110	$1	$30
3044F	The A1C test (HbA1C test) is a blood test which shows the levels of glucose (sugar) in the blood. The provider uses the test to determine if the patient’s diabetes is well controlled. The provider…	260	290	90	$1	$10
3048F	The LDL C test (low density lipoprotein cholesterol test) is a lipid profile test which shows the levels of cholesterol in the blood. The provider uses the test to determine the patient’s risk of…	194	280	70	$1	$10
0521F	The provider documents a plan of care to manage pain in a patient with cancer who receives chemotherapy or radiotherapy during the measurement period.	147	240	80	$1	$1

Showing 1–10 of 19

Jose Hernandez - Vera — Billing Profile & Reimbursement Data

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Jose Hernandez - Vera — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Frequently Asked Questions

References