Adrian Butler, MD
Hand Surgery · Tyler, TXNPI 1457473597
Payments from drug & device makers
What this record shows
The money is spread across several categories — travel and lodging (40.6%), food and beverage and education — rather than concentrated in one kind of arrangement. 27 manufacturers reported payments, led by Arthrex at 25.2% of the total. Reporting peaked in 2021 at $7,973 and has fallen 81.9% since, to $1,444 in 2025.
Across 147 payments — averaging $110.53 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Arthrex$4K
- Axogen$3K
- Zimmer Biomet$2K
- Sonex Health, Inc.$2K
- Microaire Surgical Instruments LLC$1K
- Integra Lifesciences Corporation$1K
- plus $4K from 21 others
What the payments were for
- Consulting fees$4113%
- Speaking & faculty fees$8005%
- Travel & lodging$6,60341%
- Food & beverage$5,95937%
- Education$2,47515%
General payments by program year
Who reported the general payments
Companies are grouped under their corporate parent — a single manufacturer often files under several CMS reporting entities. Research and ownership payments are counted separately and are not in this table.
| Company | Payments | Total |
|---|---|---|
| Arthrex | 22 | $4,092 |
| Axogen | 19 | $3,088 |
| Zimmer Biomet | 16 | $1,642 |
| Sonex Health, Inc. | 7 | $1,571 |
| Microaire Surgical Instruments LLC | 3 | $1,201 |
| Integra Lifesciences Corporation | 19 | $1,053 |
| Pylant Medical | 7 | $860 |
| Mid-atlantic Surgical Systems, LLC | 5 | $797 |
| Stryker | 12 | $518 |
| Johnson & Johnson | 4 | $239 |
| Anika Therapeutics, Inc. | 1 | $226 |
| Skeletal Dynamics Inc | 2 | $180 |
| Endo Pharmaceuticals Inc. | 4 | $145 |
| Medical Device Business Services, Inc. | 1 | $116 |
| Bioventus LLC | 6 | $116 |
| Medtronic | 1 | $93 |
| Endo USA, Inc. | 3 | $67 |
| Polynovo North America LLC | 3 | $51 |
| Ferring Pharmaceuticals Inc. | 2 | $40 |
| Orthofix Medical, Inc. | 3 | $33 |
| Acera Surgical, Inc. | 1 | $21 |
| Checkpoint Surgical, Inc | 1 | $21 |
| Solventum Corporation | 1 | $21 |
| Vertex | 1 | $20 |
| Smith+Nephew | 1 | $14 |
| Acell, Inc. | 1 | $13 |
| Z-medica, LLC | 1 | $11 |
What the payments were tied to
Products named in the reported payments. Only payments of $100 or more are attributed here — the typical reported payment nationally is a meal worth about $16, and listing those product-by-product would be noise.
- AVANCE NERVE GRAFT$1,817
- AXOGUARD$1,476
- ULTRAGUIDECTR$1,418
- AXOGUARD HA+ NERVE PROTECTOR$856
- AxoGuard Nerve Cap$856
- AC Joint Ziptight$835
- INTEGRA$800
- PRIMATRIX$508
- INTEGRA DERMAL REGENERATION TEMPLATE$508
- INTEGRA MESHED BILAYER WOUND MATRIX$241
- INTEGRA WOUND MATRIX (IWM)$241
- INTEGRA FLOWABLE WOUND MATRIX$241
- WristMotion$226
- VA-LCP PLATES & SCREWS$205
- VARIAX$128
- Comprehensive Reverse$124
- TENOGLIDE$119
- AxoGuard Nerve Connector$118
- AxoGuard Nerve Protector$118
- EX NAILS$116
How this compares
$16,248 in reported general payments places this provider in the 80th percentile of 170 hand surgery providers in Texas.
Medicare billing
What this is not: this is the amount Original Medicare Part B allowed for services this provider billed in 2024. It is not their income. It excludes Medicare Advantage — now more than half of all Medicare enrollment — along with Medicaid and all commercial insurance, and it is gross practice revenue before staff, rent, supplies and malpractice premiums. CMS also suppresses any figure covering ten or fewer patients, so low-volume providers appear smaller than they are.
Most prescribed under Part D
| Drug | Claims | Cost to plans & patients |
|---|---|---|
| Hydrocodone-AcetaminophenHydrocodone/Acetaminophen | 98 | $626 |
| Oxycodone-AcetaminophenOxycodone Hcl/Acetaminophen | 48 | $300 |
| Methylprednisolone | 19 | $139 |
| Acetaminophen-CodeineAcetaminophen With Codeine | 25 | $127 |
| Cephalexin | 11 | $57 |
| Tramadol Hcl | 13 | $48 |
Paid to pharmacies, not to this prescriber.
Other hand surgery in Tyler
- Ryan PattersonTyler$12K
- David RingAustin$536K
- Kourosh JafarniaHouston$278K
- Brendan MackayLubbock$274K
- John FaillaceWoodway$212K
- Daniel KoehlerDallas$208K
- Timothy NiacarisArlington$160K
- Steven NiedermeierArlington$152K
- William PientkaFort Worth$113K
- Ann GoldenDallas$107K
Where these figures come from
- Payments: CMS Open Payments, program years 2019–2025 (publication P06302026_06032026).
- Billing: Medicare Physician & Other Practitioners, data year 2024. Original Medicare Part B only.
- Identity: NPPES NPI Registry, July 2026.