What Medicare billing data cannot tell you
Allowed amounts are not income, not prices, and not most of a practice's patients. What the figures actually cover.
It is not income
The Medicare figure on a profile is the total allowed amount for services billed to Original Medicare Part B. It is gross practice revenue for those services, before staff wages, rent, equipment, malpractice cover and the cost of any drug administered in the office. It is not salary, and treating it as one overstates take-home pay by a wide and unknowable margin.
It also excludes Medicare Advantage, which now covers more than half of all Medicare enrollees, along with Medicaid and every commercial insurer. For most clinicians the figure describes a minority of their practice, and for some it describes almost none of it.
Small cells are missing on purpose
CMS suppresses any cell covering ten or fewer beneficiaries to protect patient privacy. That is the right trade, but it means published totals are systematically incomplete, and incomplete in a direction: clinicians who do a little of many things lose more to suppression than clinicians who do one thing repeatedly.
A profile with no Medicare figures is therefore not evidence that a clinician does not see Medicare patients. It is frequently evidence that they see too few of any one kind for CMS to publish.
Submitted charges are not prices
Providers submit a charge; Medicare pays its fee schedule regardless. On a common office visit the submitted figure runs well over twice the allowed amount, and the gap is a billing artefact rather than a discount, a loss or a price anyone paid.
This is why the procedure pages here never lead with the submitted charge. It is shown beside the allowed amount or not at all, because leading with it tells readers a procedure costs more than double what Medicare actually pays for it.
Prescription costs went to pharmacies
No. The Part D figure is what the plan and the beneficiary together paid the pharmacy — ingredient cost, dispensing fee and sales tax. None of it reaches the prescriber, who writes the prescription and is paid nothing by anyone for the drug.
It is also not a patient's out-of-pocket cost, and not a price. The split between plan and patient is not in the published file, and manufacturer rebates — which CMS does not publish — mean the true cost to the programme is lower by an unknown amount.