Active NPI 1144393935 Individual Practitioner Male Practitioner

Dr. Jack Michael Costa , MD

Dermatology • Fairfax, VA

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Jack Costa, MD is a certified Dermatology practicing in Fairfax, VA. With approximately 55 years of clinical experience since graduating from George Washington University School Of Medicine in 1971, Dr. Costa delivers high-quality medical care to the local community at 3650 JOSEPH SIEWICK DR.

Dr. Costa accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, destruction of skin growth, punch biopsy, first skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

3650 Joseph Siewick Dr
Suite 202

Fairfax, VA 220331710

Telephone 7033912516

Fax 7034768244

Associated Practice Facility / Clinic

🏢 Fair Oaks Orthopaedic Associates, Inc Facility NPI 1881620904

Medicare Profile & Education

Medical School

George Washington University School Of Medicine

Graduation Year

1971

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Fairfax, VA

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

55 Yrs +36.2 yrs vs City Avg

City Avg: 18.8 Yrs

State Avg: 23.2 Yrs

Regional Practice Density

32 Specialists

Practicing in Fairfax, VA (440 Statewide)

Telehealth Adoption Rate

15.6% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

52.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Costa (55 Years) 55 Yrs

Fairfax Specialty Average (18.8 Years) 18.8 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	385	79	$10.00	$7.08
17000 Destruction of skin growth	290	144	$115.00	$42.00
11104 Punch biopsy, first skin growth	250	142	$222.00	$90.94
27613 Biopsy of soft tissue of leg or ankle	207	81	$440.76	$175.75
27323 Biopsy of thigh or knee region tissue	194	92	$536.70	$282.58
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	189	167	$249.00	$184.43
17110 Destruction of up to 14 skin growths	172	112	$198.00	$73.77
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	172	91	$79.00	$58.65
21920 Biopsy of tissue of back or flank, superficial	131	74	$461.50	$164.73
24065 Biopsy of soft tissue of upper arm or elbow	108	69	$469.31	$191.26
21550 Biopsy of soft tissue of neck or chest	107	74	$469.00	$226.04
11105 Punch biopsy, each additional skin growth	101	60	$109.00	$62.91
23065 Biopsy of tissue of shoulder area	87	63	$396.26	$142.68
25065 Biopsy of surface tissue of forearm or wrist	77	56	$471.95	$216.05
10060 Simple or single drainage of skin abscess	59	50	$209.00	$96.34
99213 Established patient office or other outpatient visit, typically 15 minutes	35	29	$128.00	$93.75
10061 Complicated or multiple drainage of skin abscess	35	31	$362.00	$174.22
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	33	20	$313.00	$148.82
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	27	17	$258.00	$89.86
27040 Biopsy of tissue of pelvis and hip	27	23	$616.00	$343.72
17111 Destruction of skin growth, 15 or more growths	22	16	$234.00	$106.61
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	18	16	$187.00	$131.55
11200 Removal of skin tag, 1-15 skin tags	13	12	$157.00	$60.00
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	11	11	$441.00	$211.49

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	483	101	$10.00	$7.88
17000 Destruction of skin growth	266	149	$115.00	$45.44
11104 Punch biopsy, first skin growth	222	142	$222.00	$100.57
27323 Biopsy of thigh or knee region tissue	194	86	$535.63	$309.82
27613 Biopsy of soft tissue of leg or ankle	188	91	$465.29	$205.58
21920 Biopsy of tissue of back or flank, superficial	160	78	$456.57	$175.78
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	151	136	$249.00	$200.38
17110 Destruction of up to 14 skin growths	135	96	$198.00	$81.24
24065 Biopsy of soft tissue of upper arm or elbow	117	75	$474.94	$209.94
21550 Biopsy of soft tissue of neck or chest	114	81	$466.94	$249.87
11105 Punch biopsy, each additional skin growth	102	61	$109.00	$69.74
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	70	53	$79.00	$64.38
25065 Biopsy of surface tissue of forearm or wrist	67	51	$463.43	$226.54
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	65	52	$40.00	$27.01
23065 Biopsy of tissue of shoulder area	46	39	$389.72	$149.98
10060 Simple or single drainage of skin abscess	36	33	$209.00	$83.19
27040 Biopsy of tissue of pelvis and hip	33	26	$616.00	$337.84
10061 Complicated or multiple drainage of skin abscess	31	28	$362.00	$190.26
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	20	18	$313.00	$156.53
17004 Destruction of precancer skin growth, 15 or more growths	19	13	$269.00	$198.36
17111 Destruction of skin growth, 15 or more growths	19	18	$234.00	$127.65
99213 Established patient office or other outpatient visit, typically 15 minutes	17	16	$128.00	$101.88
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	13	12	$292.00	$157.01
40490 Biopsy of lip	13	11	$224.00	$115.37
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	12	11	$258.00	$108.59

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	582	100	$10.00	$8.21
11104 Punch biopsy, first skin growth	303	149	$222.00	$94.52
17000 Destruction of skin growth	268	149	$115.00	$47.07
27323 Biopsy of thigh or knee region tissue	257	95	$497.93	$288.03
27613 Biopsy of soft tissue of leg or ankle	202	98	$450.00	$173.44
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	193	161	$249.00	$205.89
11105 Punch biopsy, each additional skin growth	183	83	$109.00	$72.50
21920 Biopsy of tissue of back or flank, superficial	153	72	$458.00	$185.96
17110 Destruction of up to 14 skin growths	145	110	$198.00	$85.37
24065 Biopsy of soft tissue of upper arm or elbow	108	78	$469.31	$216.78
21550 Biopsy of soft tissue of neck or chest	100	66	$469.00	$256.86
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	88	59	$79.00	$66.08
25065 Biopsy of surface tissue of forearm or wrist	74	52	$463.11	$214.85
10060 Simple or single drainage of skin abscess	46	43	$209.00	$89.01
10061 Complicated or multiple drainage of skin abscess	37	32	$362.00	$192.72
23065 Biopsy of tissue of shoulder area	37	26	$388.68	$153.14
99213 Established patient office or other outpatient visit, typically 15 minutes	35	32	$128.00	$101.85
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	29	29	$187.00	$147.86
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	29	26	$40.00	$26.57
17004 Destruction of precancer skin growth, 15 or more growths	27	15	$269.00	$203.65
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	26	19	$441.00	$243.10
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	22	20	$258.00	$137.33
17111 Destruction of skin growth, 15 or more growths	21	14	$234.00	$126.38
27040 Biopsy of tissue of pelvis and hip	17	14	$616.00	$402.07
11200 Removal of skin tag, 1-15 skin tags	16	15	$157.00	$57.61
69100 Biopsy of ear	15	15	$175.00	$62.29
40490 Biopsy of lip	11	11	$224.00	$80.17

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	448	92	$8.70	$7.43
11104 Punch biopsy, first skin growth	346	166	$192.02	$92.13
11105 Punch biopsy, each additional skin growth	251	102	$93.94	$73.70
17000 Destruction of skin growth	250	133	$99.22	$46.01
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	183	156	$212.80	$190.32
27323 Biopsy of thigh or knee region tissue	178	97	$421.93	$321.86
17110 Destruction of up to 14 skin growths	173	120	$174.44	$85.21
27613 Biopsy of soft tissue of leg or ankle	166	94	$382.78	$183.27
21920 Biopsy of tissue of back or flank, superficial	119	71	$400.33	$208.37
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	103	67	$159.06	$138.72
21550 Biopsy of soft tissue of neck or chest	93	68	$416.81	$270.12
24065 Biopsy of soft tissue of upper arm or elbow	85	65	$397.42	$203.07
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	62	48	$75.58	$64.21
10060 Simple or single drainage of skin abscess	61	54	$189.65	$88.35
25065 Biopsy of surface tissue of forearm or wrist	60	50	$365.48	$228.10
10061 Complicated or multiple drainage of skin abscess	47	42	$313.70	$186.55
23065 Biopsy of tissue of shoulder area	42	37	$325.27	$153.51
99213 Established patient office or other outpatient visit, typically 15 minutes	38	35	$107.68	$96.33
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	22	18	$380.94	$250.23
27040 Biopsy of tissue of pelvis and hip	18	18	$547.65	$422.51
69100 Biopsy of ear	16	15	$160.43	$64.04
11200 Removal of skin tag, 1-15 skin tags	13	11	$144.88	$58.37
40490 Biopsy of lip	12	12	$192.84	$94.17

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	583	110	$6.75	$6.63
11104 Punch biopsy, first skin growth	338	166	$148.41	$89.18
17000 Destruction of skin growth	287	152	$77.03	$44.97
11105 Punch biopsy, each additional skin growth	230	102	$72.72	$72.06
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	228	184	$166.17	$164.76
17110 Destruction of up to 14 skin growths	197	139	$132.24	$81.16
27323 Biopsy of thigh or knee region tissue	172	98	$330.90	$302.20
27613 Biopsy of soft tissue of leg or ankle	169	99	$300.75	$175.90
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	153	97	$124.37	$123.46
21920 Biopsy of tissue of back or flank, superficial	104	79	$305.80	$180.39
21550 Biopsy of soft tissue of neck or chest	98	77	$312.43	$269.19
24065 Biopsy of soft tissue of upper arm or elbow	86	62	$309.74	$223.51
25065 Biopsy of surface tissue of forearm or wrist	67	52	$306.73	$240.45
10061 Complicated or multiple drainage of skin abscess	56	47	$241.87	$192.90
10060 Simple or single drainage of skin abscess	52	47	$139.58	$84.96
99213 Established patient office or other outpatient visit, typically 15 minutes	48	41	$85.13	$83.62
23065 Biopsy of tissue of shoulder area	39	35	$262.79	$163.09
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	31	20	$297.77	$235.80
17111 Destruction of skin growth, 15 or more growths	29	22	$167.87	$122.15
27040 Biopsy of tissue of pelvis and hip	28	24	$410.96	$409.31
69100 Biopsy of ear	20	16	$116.71	$73.18
17004 Destruction of precancer skin growth, 15 or more growths	14	11	$180.71	$179.71
11200 Removal of skin tag, 1-15 skin tags	12	11	$104.48	$52.91

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	844	122	$6.82	$6.35
17000 Destruction of skin growth	316	170	$77.21	$43.03
11104 Punch biopsy, first skin growth	311	173	$147.70	$86.60
17110 Destruction of up to 14 skin growths	234	162	$131.67	$78.76
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	231	189	$165.87	$154.78
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	179	119	$123.83	$117.42
11105 Punch biopsy, each additional skin growth	176	89	$73.05	$68.44
27323 Biopsy of thigh or knee region tissue	143	101	$330.04	$284.98
27613 Biopsy of soft tissue of leg or ankle	126	85	$300.45	$173.20
21920 Biopsy of tissue of back or flank, superficial	123	85	$305.70	$177.52
21550 Biopsy of soft tissue of neck or chest	110	82	$312.76	$244.83
24065 Biopsy of soft tissue of upper arm or elbow	88	68	$309.42	$214.95
25065 Biopsy of surface tissue of forearm or wrist	82	61	$305.81	$219.24
10060 Simple or single drainage of skin abscess	79	71	$140.21	$83.77
10061 Complicated or multiple drainage of skin abscess	71	63	$241.77	$159.37
99213 Established patient office or other outpatient visit, typically 15 minutes	58	44	$85.31	$78.28
23065 Biopsy of tissue of shoulder area	55	47	$262.41	$138.98
17004 Destruction of precancer skin growth, 15 or more growths	45	22	$180.71	$168.34
17111 Destruction of skin growth, 15 or more growths	38	25	$164.80	$123.32
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	37	30	$292.59	$232.95
27040 Biopsy of tissue of pelvis and hip	36	31	$414.13	$359.77
11200 Removal of skin tag, 1-15 skin tags	23	22	$104.81	$61.25
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	17	17	$52.47	$49.98
69100 Biopsy of ear	16	15	$117.56	$62.54

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	638	109	$8.75	$5.85
17000 Destruction of skin growth	297	168	$81.59	$45.01
11100 Biopsy of single growth of skin and/or tissue	281	165	$106.03	$62.70
17110 Destruction of up to 14 skin growths	267	170	$114.14	$80.47
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	238	187	$152.14	$146.07
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	206	149	$111.85	$109.30
11101 Biopsy of each additional growth of skin and/or tissue	180	94	$34.95	$34.12
27323 Biopsy of thigh or knee region tissue	119	83	$289.37	$255.00
21920 Biopsy of tissue of back or flank, superficial	110	77	$263.59	$183.20
27613 Biopsy of soft tissue of leg or ankle	104	80	$269.28	$170.18
24065 Biopsy of soft tissue of upper arm or elbow	91	72	$266.77	$220.71
21550 Biopsy of soft tissue of neck or chest	80	63	$276.64	$243.72
10060 Simple or single drainage of skin abscess	78	66	$118.31	$89.49
25065 Biopsy of surface tissue of forearm or wrist	70	53	$252.52	$185.58
10061 Complicated or multiple drainage of skin abscess	61	53	$201.84	$164.35
23065 Biopsy of tissue of shoulder area	59	53	$230.09	$139.83
17004 Destruction of precancer skin growth, 15 or more growths	39	31	$196.46	$155.13
17111 Destruction of skin growth, 15 or more growths	35	27	$132.95	$94.46
99213 Established patient office or other outpatient visit, typically 15 minutes	34	32	$74.02	$70.43
27040 Biopsy of tissue of pelvis and hip	33	23	$389.12	$368.51
11200 Removal of skin tag, 1-15 skin tags	22	18	$106.36	$65.00
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	16	14	$143.69	$98.58
69100 Biopsy of ear	14	12	$121.48	$63.67
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	13	13	$242.34	$190.81

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	698	122	$8.97	$6.10
17000 Destruction of skin growth	315	169	$81.76	$42.18
11100 Biopsy of single growth of skin and/or tissue	295	171	$106.08	$59.32
17110 Destruction of up to 14 skin growths	287	185	$114.16	$77.15
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	271	180	$112.19	$106.61
27323 Biopsy of thigh or knee region tissue	170	119	$288.39	$258.00
27613 Biopsy of soft tissue of leg or ankle	158	106	$270.16	$163.10
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	157	136	$152.31	$141.56
11101 Biopsy of each additional growth of skin and/or tissue	147	90	$35.29	$33.65
10061 Complicated or multiple drainage of skin abscess	107	87	$202.15	$157.03
21920 Biopsy of tissue of back or flank, superficial	105	61	$270.63	$189.49
21550 Biopsy of soft tissue of neck or chest	104	80	$282.17	$241.61
24065 Biopsy of soft tissue of upper arm or elbow	102	78	$267.12	$193.67
25065 Biopsy of surface tissue of forearm or wrist	93	73	$264.25	$201.37
10060 Simple or single drainage of skin abscess	81	78	$117.83	$81.59
99213 Established patient office or other outpatient visit, typically 15 minutes	53	46	$73.96	$71.79
23065 Biopsy of tissue of shoulder area	45	41	$234.11	$141.61
17004 Destruction of precancer skin growth, 15 or more growths	43	32	$198.40	$162.89
27040 Biopsy of tissue of pelvis and hip	39	35	$380.15	$351.40
17111 Destruction of skin growth, 15 or more growths	30	21	$133.62	$106.45
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	27	25	$46.47	$45.15
11400 Removal of growth (0.5 centimeters or less) of the trunk, arms or legs	25	23	$137.71	$70.49
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	17	12	$241.08	$185.71
69100 Biopsy of ear	15	15	$121.62	$54.94
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	12	11	$160.20	$87.25

Medical Specialties & State Licenses

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License VA 0101028288

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Blue Cross Blue Shield

9320 (VA)

Commercial Insurance / Payer ID Anthem

003539 (VA)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

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Doctor of Medicine (M.D.)

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Orthopaedic Surgery

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Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active December 30, 2010

NPI status registered as active in NPPES database

📍

Updated Practice Location December 30, 2010

Registered at 3650 JOSEPH SIEWICK DR, SUITE 202, FAIRFAX, VA 220331710 (Tel: 7033912516)

📍

Updated Business Mailing Address December 30, 2010

Registered at 3650 JOSEPH SIEWICK DRIVE, SUITE 202, FAIRFAX, VA 22033 (Tel: 7033912516)

👤

Provider Name / Credentials Updated December 30, 2010

Recorded as JACK COSTA, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) December 30, 2010

Dermatology (License #0101028288 in VA)

🟢

Initial NPI Registration & Enumeration November 17, 2006

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1144393935

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: November 17, 2006

Last Update: December 30, 2010

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

3650 Joseph Siewick Drive, Suite 202

Fairfax, VA 22033

Phone: 7033912516

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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