Puerto Rico Medicare Revenue Analysis
CMS Medicare Physician & Other Practitioners data
Puerto Rico has 4K Medicare providers who collectively received $55.2M in Medicare payments, averaging $15K per provider. With below-average per-provider Medicare revenue, Puerto Rico practices may have substantial untapped potential in care management programs and E&M coding optimization.
The most common specialty is Clinical Laboratory with 387 providers, followed by Internal Medicine (381) and General Practice (306). Clinical Laboratory providers in Puerto Rico average $13K annually, with room to grow through CCM, RPM, and AWV program adoption.
The largest Medicare provider concentration is in San Juan (1,013 providers), with Bayamon and Ponce also serving as major healthcare hubs. Practices in these areas face competitive pressure, making revenue optimization through proper coding and program enrollment critical for financial performance.
Total Providers
4K
in Puerto Rico
Total Medicare Payment
$55.2M
Avg Payment / Provider
$15K
Total Services
2.1M
Puerto Rico Performance Signals
Revenue per Provider
$15,080
-81.1% vs benchmark · national avg $79,744
Provider Market Share
0.3% of US
-84.4% vs benchmark · 3,663 providers
CCM Adoption
0.1%
-99.3% vs benchmark · national 11.3%
RPM Adoption
0.0%
-100.0% vs benchmark · national 6.5%
AWV Completion
0.5%
-96.9% vs benchmark · national 17.5%
Key Stats
How This Compares
Top Opportunities
How Puerto Rico Compares
Top Revenue Opportunities in Puerto Rico
Chronic Care Management (99490)
Only 0.1% of providers bill CCM vs 11.3% national average. 410 additional providers could adopt CCM to close this gap.
Annual Wellness Visits (G0438/G0439)
AWV completion at 0.5% trails the 17.5% national average. 620 additional providers could offer AWV services.
Remote Patient Monitoring (99454)
RPM adoption is 0.0% vs 6.5% nationally. 237 providers could implement RPM programs.
Market Opportunities by Specialty
Top Specialties in Puerto Rico
| Specialty | Providers | Avg Payment |
|---|---|---|
| Clinical Laboratory | 387 | $13K |
| Internal Medicine | 381 | $12K |
| General Practice | 306 | $6K |
| Cardiology | 206 | $15K |
| Ophthalmology | 171 | $17K |
| Diagnostic Radiology | 161 | $17K |
| Gastroenterology | 119 | $8K |
| Physical Medicine and Rehabilitation | 105 | $21K |
| Emergency Medicine | 97 | $20K |
| Pulmonary Disease | 90 | $15K |
| Neurology | 85 | $15K |
| Centralized Flu | 85 | $73K |
| Ambulance Service Provider | 84 | $19K |
| Orthopedic Surgery | 84 | $10K |
| Nephrology | 84 | $18K |
| Family Practice | 80 | $10K |
| Dermatology | 72 | $22K |
| Endocrinology | 71 | $10K |
| Urology | 70 | $10K |
| Obstetrics & Gynecology | 68 | $5K |
Top Cities in Puerto Rico
San Juan
Bayamon
Ponce
Caguas
Mayaguez
Carolina
Guaynabo
Manati
Arecibo
Aguadilla
Hato Rey
Cayey
Humacao
San German
Rio Piedras
Fajardo
Santurce
Toa Baja
Guayama
Vega Baja
Dorado
Hatillo
Aibonito
Aguada
San Sebastian
Cabo Rojo
Toa Alta
Trujillo Alto
Coamo
Juana Diaz
Top 50 Providers in Puerto Rico
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