This provider's $5.8M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 427% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 252% in 2023
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $107.07 | $54.91 | 1.95x | $52.16 | $375.7K | 14.1K | 7.5K |
| 2015 | $114.62 | $60.65 | 1.89x | $53.97 | $494.5K | 12.9K | 7.5K |
| 2016 | $140.94 | $56.71 | 2.49x | $84.23 | $461.4K | 11.6K | 7.3K |
| 2017 | $131.43 | $51.21 | 2.57x | $80.22 | $433.5K | 13.8K | 7.7K |
| 2018 | $135.77 | $51.71 | 2.63x | $84.06 | $332.3K | 9.8K | 6.0K |
| 2019 | $136.74 | $49.93 | 2.74x | $86.81 | $393.7K | 10.6K | 6.0K |
| 2020 | $146.74 | $56.03 | 2.62x | $90.71 | $375.9K | 5.7K | 4.1K |
| 2021 | $151.62 | $60.83 | 2.49x | $90.79 | $403.7K | 7.9K | 5.2K |
| 2022 | $184.38 | $77.64 | 2.37x | $106.74 | $562.8K | 7.1K | 3.9K |
| 2023 | $172.37 | $72.44 | 2.38x | $99.93 | $2.0M | 16.8K | 4.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 95816 | Measurement of brain wave activity (eeg), awake and drowsy | 3.0K | $1.1M | $351.97 | 1.49x |
| 99350 | Established patient home visit, typically 60 minutes | 4.9K | $687.6K | $141.27 | 2.68x |
| 99337 | Established patient assisted living visit, typically 60 minutes | 2.7K | $419.1K | $153.51 | 2.65x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.5K | $327.8K | $93.81 | 2.31x |
| 96112 | Administration of developmental test, first hour | 2.5K | $258.6K | $104.99 | 1.81x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 1.8K | $223.3K | $127.43 | 2.03x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.6K | $195.6K | $76.19 | 2.02x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.3K | $166.6K | $127.08 | 2.39x |
| 11043 | Removal of skin and/or muscle first 20 sq cm or less | 861 | $156.2K | $181.36 | 2.35x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 680 | $146.9K | $216.03 | 2.27x |
| 17004 | Destruction of 15 or more skin growths | 807 | $105.8K | $131.05 | 2.72x |
| 93923 | Ultrasound study of arteries of both arms and legs | 1.1K | $100.5K | $94.73 | 2.54x |
| 99345 | New patient home visit, typically 75 minutes | 581 | $97.4K | $167.62 | 2.70x |
| 83880 | Natriuretic peptide (heart and blood vessel protein) level | 2.3K | $97.2K | $42.03 | 2.18x |
| 90901 | Biofeedback training | 2.6K | $94.7K | $36.14 | 2.08x |
| G0180 | Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple | 2.2K | $93.4K | $43.30 | 2.68x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 1.2K | $82.5K | $66.25 | 2.81x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 602 | $81.9K | $136.06 | 2.49x |
| 90662 | Vaccine for influenza for injection into muscle | 1.4K | $76.0K | $55.10 | 1.69x |
| G0179 | Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial im | 2.2K | $73.2K | $33.60 | 2.73x |
This provider submits charges 2.27 times higher than what Medicare actually pays.
A markup ratio of 2.27x means for every $100 Medicare pays, this provider initially charges $227. This is higher than the national average.
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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