Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerNPI Medicare & MedicaidDaniel Falcon
    Ask Trek AI about this page

    Daniel Falcon — Billing Profile & Reimbursement Data

    NPI 1942210216 · Spartanburg, SC · Surgery of the Hand (Surgery) Physician

    Customize your policy alerts

    Sign up for Daniel Falcon — Billing Profile & Reimbursement Data policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Daniel Falcon is a surgery of the hand (surgery) physician provider located in Spartanburg, South Carolina. This profile covers 25 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.

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationDaniel Falcon
    Address391 Serpentine Dr
    CitySpartanburg
    StateSC
    ZIP29303
    TaxonomySurgery of the Hand (Surgery) Physician
    NPI EnumeratedAugust 9, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$156.8K
    Medicaid$0

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    25 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    99204The 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…310$110$33.6K
    26160In this procedure, the provider excises a lesion, like a cyst or ganglion, from a tendon sheath or joint capsule in the hand or finger.40$420$17K
    26055Trigger finger, or stenosing tenosynovitis, is when a finger remains in a bent position. It is painful to open or close the finger. A swollen tendon or formation of knots or nodules in the tendon may…40$390$16.3K
    64721Neuroplasty or transposition of the median nerve at the carpal tunnel is done to treat a condition called carpal tunnel syndrome (CTS). The carpal tunnel is a narrow tunnel in the wrist through which…50$290$15.1K
    26123The provider surgically removes fascial tissue from part of the palm and releases one finger, including the middle joint of that finger. Treatment may include Z–plasty, rearranging local tissue, or…20$620$13.7K
    99213The 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…170$60$10.4K
    99214The 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…80$90$7K
    26125In this add on procedure to palmar fasciectomy, the provider surgically releases constriction in an additional finger, including the middle joint of that finger. Treatment may include Z–plasty,…30$200$5.6K
    20550Aponeurosis is an abnormal sheet like extension of the tendon. Injection of a tendon or ligament is the medical therapeutic procedure to reduce the aponeurosis formation.150$40$5.3K
    64718In this procedure, the provider uses an open approach to incise scar tissue or other sources of pressure to relieve tension on the ulnar nerve at the elbow, which an injury or swelling within the…10$430$5.1K

    Showing 1–10 of 25

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 25 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    25 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    992145,2167,860160$80$23.2K
    64721236040$400$20.4K
    975301,1501,250600$20$20K
    971101,1631,390710$20$19.2K
    26055337040$260$12.4K
    2612311010$740$11.2K
    992132,5487,690100$60$10.8K
    97763610240$30$7.8K
    971401,0191,100240$20$6.9K
    2616011020$380$6.9K

    Showing 1–10 of 25

    Nearby Providers

    Other providers in the same ZIP code as Daniel Falcon, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Spartanburg Medical CenterSCGeneral Acute Care Hospital$0$187.7M
    Axcess Healthcare Services, LLCSCNursing Care Agency$0$98.5M
    South Carolina Dept Of Mental Health Accounting OfficeSCMental Health Clinic/Center (Including Community Mental Health Center)$0$40M
    Spartanburg Medical CenterSCEmergency Medicine Physician$0$17.2M
    Spartanburg Medical CenterSCFamily Medicine Physician$0$17M
    Spartanburg Medical CenterSCMaternal & Fetal Medicine Physician$0$11.5M
    Better Beginnings, IncSCPediatric Occupational Therapist$0$6.9M
    Whitney Road Dental Health Center, P.C.SCGeneral Practice Dentistry$0$6.3M
    Foothills Pediatric Dentistry, PASCPediatric Dentistry$0$4.9M
    Bhg Xxxviii, LLCSCSubstance Use Disorder Rehabilitation Clinic/Center$264.8K$3.5M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. South Carolina Distribution
    Daniel Falcon — 4 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — South Carolina