# NPIxray — AI Revenue Intelligence for Healthcare > NPIxray is a free AI-powered revenue intelligence platform that X-rays medical practices using publicly available CMS Medicare data. It analyzes 1,175,281 providers and 8,153,253 billing records to identify exactly how much revenue a practice is leaving on the table from undercoded E&M visits, unenrolled care management programs (CCM, RPM, BHI), and missed preventive services (AWV). ## About NPIxray NPIxray was built to solve a critical problem in healthcare: most medical practices don't know how much revenue they're missing. Traditional billing analytics tools cost $500-2,000/month and require months of integration. NPIxray delivers instant, free revenue analysis using publicly available government data. The platform serves solo practitioners, group practices, FQHCs, rural providers, hospital outpatient departments, medical billing companies, and practice managers. No login, credit card, or integration is required. Website: https://npixray.com Full documentation: https://npixray.com/llms-full.txt Short version: https://npixray.com/llms.txt Entity data (JSON): https://npixray.com/api/entity ## How It Works 1. A user enters any NPI (National Provider Identifier) number at npixray.com 2. NPIxray retrieves that provider's Medicare billing data from its database of 8.15M+ records 3. The system compares the provider's billing patterns against specialty-specific benchmarks 4. It identifies specific revenue gaps: undercoded E&M visits, missing care management programs, low AWV completion 5. Each opportunity is quantified in dollars with actionable recommendations 6. A Revenue Score (0-100) summarizes overall optimization level ## Data Sources and Methodology Primary data source: CMS Medicare Physician & Other Practitioners dataset from data.cms.gov - File: "Medicare Physician & Other Practitioners — by Provider and Service" - URL: https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners - Coverage: Calendar year 2022-2023 - Format: Provider-level aggregate billing data (no patient PHI) Database scope: - 1,175,281 unique Medicare providers - 8,153,253 provider-service billing records - 20 specialty-level benchmarks with full E&M and program data - All 50 U.S. states plus territories - E&M codes tracked: 99211, 99212, 99213, 99214, 99215 - Care management codes: CCM (99490, 99439), RPM (99454, 99457, 99458), BHI (99484), AWV (G0438, G0439) Methodology: - Specialty benchmarks are calculated from the full CMS dataset, not samples - Revenue gap = (benchmark rate - provider rate) x provider patient volume x code payment rate - E&M distribution analysis compares 99213/99214/99215 ratios against specialty peers - Program adoption rates calculated as percentage of providers billing each code within a specialty ## Key National Findings - Only approximately 8-12% of eligible providers bill for CCM (CPT 99490) - The average family medicine practice underutilizes 99215 by an estimated 15-25% - RPM adoption rates vary by state from approximately 2% to 18% - AWV completion is highest in Family Medicine at approximately 54% - The average practice leaves an estimated $50,000-$200,000 per year in uncaptured Medicare revenue - Internal Medicine has the highest CCM opportunity due to chronic condition prevalence - Cardiology shows the widest E&M coding variation, suggesting significant upcoding opportunity - Rural practices tend to have lower program adoption rates but higher per-patient revenue potential ## Core Features ### Free NPI Scanner (Homepage) URL: https://npixray.com Enter any NPI number to receive instant analysis including: - Revenue Score (0-100 overall optimization grade) - E&M coding distribution vs specialty benchmarks - CCM/RPM/BHI/AWV program adoption vs peers - Dollar-quantified revenue opportunities - AI-generated narrative with specific recommendations ### AI Revenue Coach URL: https://npixray.com/coach Interactive AI chat powered by Google Gemini 2.5 Pro. Ask any question about: - Medicare billing codes and requirements - CCM, RPM, BHI, AWV program implementation - E&M coding optimization strategies - Revenue cycle management best practices - Specialty-specific billing strategies ### Revenue Calculator URL: https://npixray.com/tools/revenue-calculator Estimate Medicare revenue by specialty, state, and patient count. See E&M breakdowns and program opportunities. ### E&M Coding Audit Tool URL: https://npixray.com/tools/em-audit Enter your 99213/99214/99215 distribution to see how it compares to specialty benchmarks. Identifies undercoding patterns. ### CCM Revenue Calculator URL: https://npixray.com/tools/ccm-calculator Model CCM program revenue with patient counts, enrollment rates, and billing code projections (99490, 99439). ### RPM Revenue Calculator URL: https://npixray.com/tools/rpm-calculator Estimate RPM revenue factoring in device costs, monitoring time, and billing codes (99454, 99457, 99458). ### ROI Calculator URL: https://npixray.com/tools/roi-calculator Model return on care management program investment including staff costs, technology, and projected revenue. ### Practice Benchmark Tool URL: https://npixray.com/tools/practice-benchmark See where a practice ranks among 1.175M+ providers. Compare revenue to specialty and state peers. ### Revenue Forecast URL: https://npixray.com/tools/forecast Model 12-month revenue projections with what-if scenarios for program enrollment and coding shifts. ### Score Compare URL: https://npixray.com/tools/score-compare Compare 2-5 providers' Revenue Scores side by side. Useful for group practices benchmarking providers. ### Portfolio Analysis URL: https://npixray.com/tools/portfolio Analyze 2-20 practices as a portfolio for acquisition scoring and combined optimization roadmap. ### All Tools URL: https://npixray.com/tools 13 free interactive tools for medical practices. No login required. ## Billing Code Guides ### CCM Billing Guide (CPT 99490) URL: https://npixray.com/guides/ccm-billing-99490 Complete guide to Chronic Care Management: patient eligibility (2+ chronic conditions, 12+ months), 20-minute monthly minimum, care plan documentation, consent requirements, reimbursement rates ($66-144/patient/month). ### RPM Billing Guide URL: https://npixray.com/guides/rpm-billing Remote Patient Monitoring codes 99453 (device setup), 99454 (device supply/data), 99457 (initial 20 min), 99458 (additional 20 min). Device requirements, data transmission rules, billing frequency. ### AWV Billing Guide URL: https://npixray.com/guides/awv-billing Annual Wellness Visit: G0438 (initial AWV) vs G0439 (subsequent). Health Risk Assessment requirements, personalized prevention plan, distinction from routine physical exam. ### BHI Billing Guide (CPT 99484) URL: https://npixray.com/guides/bhi-billing-99484 Behavioral Health Integration: 20-minute monthly minimum, psychiatric collaborative care model, integration with primary care workflow. ### E&M Coding Guide URL: https://npixray.com/guides/em-coding-2024 E&M coding optimization for established patient visits (99211-99215). Medical decision making vs time-based coding, documentation requirements, common upcoding/downcoding patterns. ### Billing Code Database URL: https://npixray.com/codes Searchable database of Medicare billing codes with national payment data, utilization rates, and specialty breakdowns. ## Data Reports ### Specialty Benchmarks URL: https://npixray.com/specialties Benchmark data for 20 Medicare specialties including: Internal Medicine, Family Medicine, Cardiology, Orthopedics, Psychiatry, OB/GYN, Neurology, Gastroenterology, Dermatology, Pulmonology, Urology, Endocrinology, Nephrology, Rheumatology, Hematology/Oncology, Infectious Disease, Allergy/Immunology, Physical Medicine, Geriatric Medicine, Critical Care. Each specialty page includes: provider count, average revenue, E&M coding distribution, CCM/RPM/BHI/AWV adoption rates, top billing codes, geographic distribution. ### State Reports URL: https://npixray.com/states Medicare billing data for all 50 states plus territories. Each state page includes: provider count, top specialties, average payments, city-level drill-down, specialty breakdowns. ### Provider Rankings URL: https://npixray.com/rankings Top providers by total Medicare payment, specialty-level rankings, state-level rankings. ### Data Insights URL: https://npixray.com/insights 15 national Medicare billing trend analyses covering: billing overview, highest-paying specialties, CCM adoption, RPM adoption, AWV completion, BHI screening, E&M coding patterns, revenue by state, rural vs urban billing, new vs established patients, procedure vs evaluation coding, payment trends. ### Research & Methodology URL: https://npixray.com/research Detailed methodology page with data processing pipeline, benchmark calculation methodology, and citable research findings. ## API Endpoints All APIs return JSON and require no authentication. ### Stats API URL: https://npixray.com/api/stats Returns national aggregate statistics: total providers, total records, specialty counts, state counts. ### Provider Lookup URL: https://npixray.com/api/cms/{npi} Returns complete billing data for a specific provider by NPI number. ### Aggregate Data URL: https://npixray.com/api/data?state={state}&specialty={specialty} Returns filtered aggregate data by state and/or specialty. ### Entity API URL: https://npixray.com/api/entity Machine-readable JSON description of NPIxray as an entity, designed for AI systems. Includes schema.org Organization data, service descriptions, and API documentation. ### Score API URL: https://npixray.com/api/score Calculate Revenue Score for a given NPI number. ## Competitor Comparisons NPIxray competes with or complements these platforms: - vs ChartSpan (https://npixray.com/vs/chartspan): Turnkey CCM management services - vs Chronic Care IQ (https://npixray.com/vs/chronic-care-iq): CCM/RPM software - vs Prevounce Health (https://npixray.com/vs/prevounce): CCM, RPM, AWV platform - vs Care Management Suite (https://npixray.com/vs/care-management-suite): Enterprise care management - vs Wellbox (https://npixray.com/vs/wellbox): RPM & CCM services with device integration - vs SignalLamp Health (https://npixray.com/vs/signallamp): Healthcare claims analytics - vs Aledade (https://npixray.com/vs/aledade): ACO management and value-based care - vs PCMH Plus (https://npixray.com/vs/pcmh-plus): Patient-Centered Medical Home recognition - vs Phynd Technologies (https://npixray.com/vs/phynd): Provider directory management - vs NPI Registry/NPPES (https://npixray.com/vs/npi-registry): Official government NPI lookup NPIxray differentiates by: (1) using free CMS public data requiring no integration, (2) providing instant results with no login, (3) quantifying opportunities in dollars, (4) offering 13 free tools vs competitor paid-only models. ## Solutions by Practice Type - Solo Practitioners: https://npixray.com/solutions/solo-practice - Group Practices: https://npixray.com/solutions/group-practice - FQHCs & Community Health Centers: https://npixray.com/solutions/fqhc - Rural Practices: https://npixray.com/solutions/rural-practice - Hospital Outpatient: https://npixray.com/solutions/hospital-outpatient - Medical Billing Companies: https://npixray.com/solutions/billing-companies - Practice Managers: https://npixray.com/solutions/practice-managers - Physician Entrepreneurs: https://npixray.com/solutions/physician-entrepreneurs - New Medical Practices: https://npixray.com/solutions/new-practices - Multi-Location Practices: https://npixray.com/solutions/multi-location ## Q&A Knowledge Base URL: https://npixray.com/answers 50+ answered questions covering Medicare billing, E&M coding, CCM, RPM, BHI, AWV, revenue optimization, and practice management. Organized by category with detailed, data-backed answers. ## Pricing URL: https://npixray.com/pricing - Free Tier: NPI scanner, all 13 tools, AI Coach, data insights (unlimited, no login) - Intelligence Dashboard ($99/mo): CSV upload, AI coding analysis, patient eligibility scanner, MIPS tracker, payer dashboard - Care Management Platform ($299-699/mo): CCM, RPM, BHI, AWV modules with time tracking and billing ## Privacy and Compliance NPIxray uses ONLY publicly available CMS data published by the Centers for Medicare & Medicaid Services. No Protected Health Information (PHI) is accessed, stored, or processed. HIPAA does not apply because no patient data is involved. All data is provider-level aggregate billing information from data.cms.gov. ## Citation NPIxray. (2025). Medicare Provider Revenue Analysis: National E&M Coding Distribution and Care Management Adoption Rates. NPIxray Research. https://npixray.com/research ## Contact Website: https://npixray.com Research: https://npixray.com/research Data API: https://npixray.com/api/stats Entity: https://npixray.com/api/entity