Managed care
Apcg Urology C S P
Apcg Urology C S P was paid $2.00M by Medicaid between Jan 2018 and Oct 2024, across 25 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 33% of everything it billed.
33Billing provider infoAPCG UROLOGY C S P
GUAYAMA, PR 00784
GUAYAMA, PR 00784
33aNPI1285777326assigned 02/15/2007
33bProvider typeExclusive Provider Organization
28Total paid$2.00M
24GClaims41,688
24DCodes billed25
24AFirst – last monthJan 2018 – Oct 2024
Compared with peers
Next to other Exclusive Provider Organization providers in Puerto Rico
Rank by total paid#2 of 19
Median peer was paid$250K
This provider vs. median8.0×
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 | 12,650 | $463K | |
| 2019 | 9,345 | $359K | |
| 2020 | 5,475 | $236K | |
| 2021 | 6,049 | $388K | |
| 2022 | 4,651 | $312K | |
| 2023 | 2,305 | $144K | |
| 2024incomplete | 1,213 | $92K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 33% | 18,276 | 16,537 | $660K |
| 76872 | 16% | 3,605 | 3,360 | $329K | |
| 76770 | 15% | 4,066 | 3,787 | $298K | |
| 99203 | Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity | 12% | 4,875 | 4,521 | $237K |
| 76856 | Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | 6.6% | 2,337 | 2,132 | $131K |
| 76870 | 4.1% | 1,260 | 1,165 | $82K | |
| 51741 | 4.0% | 2,952 | 2,723 | $80K | |
| 52000 | 3.8% | 706 | 644 | $76K | |
| 76857 | 1.4% | 557 | 535 | $29K | |
| 96402 | 1.3% | 758 | 678 | $26K | |
| 52332 | 1.0% | 93 | 83 | $20K | |
| 99233 | Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m | <1% | 337 | 267 | $17K |
13 more codes
| 99283 | Emergency room visit (moderate) | <1% | 128 | $4K |
| 99223 | Prolong inpt eval add15 m | <1% | 72 | $3K |
| 99238 | Hospital discharge day management, 30 minutes or less | <1% | 119 | $3K |
| G9868 | Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes | 0% | 15 | $0.00 |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | 0% | 350 | $0.00 |
| G9903 | Patient screened for tobacco use and identified as a tobacco non-user | 0% | 334 | $0.00 |
| G8420 | Bmi is documented within normal parameters and no follow-up plan is required | 0% | 250 | $0.00 |
| G8950 | Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented | 0% | 183 | $0.00 |
| 1123F | 0% | 37 | $0.00 | |
| 1124F | 0% | 48 | $0.00 | |
| G8427 | Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications | 0% | 209 | $0.00 |
| G8783 | Normal blood pressure reading documented, follow-up not required | 0% | 105 | $0.00 |
| G8431 | Screening for depression is documented as being positive and a follow-up plan is documented | 0% | 16 | $0.00 |
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.
From NPPES
Who's on the registration
Authorized officialCORICA GUINLE, ALBERTO (ADMINISTRATOR)