Physician
Ortega, Hiram
Ortega, Hiram was paid $3.15M by Medicaid between Jan 2018 and Dec 2024, across 10 billing codes. Its largest line is 45385, Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) — 38% of everything it billed.
33Billing provider infoORTEGA, HIRAM
AGUADILLA, PR 00603
AGUADILLA, PR 00603
33aNPI1184828295assigned 06/13/2007
33bProvider typeGastroenterology Physician
28Total paid$3.15M
24GClaims19,999
24DCodes billed10
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Gastroenterology Physician providers in Puerto Rico
Rank by total paid#1 of 107
Median peer was paid$47K
This provider vs. median67×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 4,309 | $389K | |
| 2019 | 12 | $1K | |
| 2020 | 1,482 | $179K | |
| 2021 | 1,091 | $180K | |
| 2022 | 3,621 | $655K | |
| 2023 | 5,111 | $917K | |
| 2024incomplete | 4,373 | $827K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 45385 | Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) | 38% | 2,305 | 1,976 | $1.19M |
| 43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | 21% | 2,013 | 1,708 | $661K |
| 99070 | 14% | 5,078 | 4,016 | $455K | |
| 99204 | Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | 12% | 3,936 | 3,353 | $374K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 8.9% | 5,303 | 4,647 | $281K |
| 45378 | Colonoscopy, flexible; diagnostic, including collection of specimen(s) | 2.5% | 302 | 265 | $79K |
| 45380 | Colonoscopy, flexible; with biopsy, single or multiple | 2.4% | 287 | 266 | $76K |
| 99203 | Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity | 1.0% | 422 | 385 | $32K |
| G0500 | Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) | <1% | 333 | 253 | $2K |
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | <1% | 20 | 20 | $2K |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.