This provider's $6.4M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 855% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 231% in 2021
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 | $113.71 | $33.38 | 3.41x | $80.33 | $167.0K | 4.3K | 2.1K |
| 2015 | $162.12 | $30.78 | 5.27x | $131.34 | $193.8K | 5.0K | 2.5K |
| 2016 | $223.37 | $37.33 | 5.98x | $186.04 | $195.4K | 5.0K | 2.6K |
| 2017 | $235.35 | $31.61 | 7.45x | $203.74 | $194.2K | 5.6K | 2.8K |
| 2018 | $66.00 | $29.22 | 2.26x | $36.78 | $185.2K | 5.6K | 2.8K |
| 2019 | $154.51 | $48.42 | 3.19x | $106.09 | $449.6K | 8.7K | 3.5K |
| 2020 | $154.36 | $47.52 | 3.25x | $106.84 | $398.2K | 7.9K | 3.6K |
| 2021 | $155.72 | $48.04 | 3.24x | $107.68 | $1.3M | 18.0K | 6.0K |
| 2022 | $180.42 | $64.21 | 2.81x | $116.21 | $1.7M | 22.7K | 6.7K |
| 2023 | $130.48 | $39.70 | 3.29x | $90.78 | $1.6M | 22.9K | 7.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 29.5K | $2.1M | $71.63 | 2.85x |
| 99349 | Established patient home visit, typically 40 minutes | 12.3K | $1.2M | $95.34 | 4.01x |
| 99358 | Prolonged patient service without direct patient contact first hour | 10.0K | $830.3K | $83.39 | 3.98x |
| 99350 | Established patient home visit, typically 60 minutes | 3.4K | $451.4K | $134.64 | 3.94x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 6.9K | $320.2K | $46.67 | 2.61x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 2.8K | $308.6K | $108.90 | 3.26x |
| G0181 | Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow | 2.3K | $182.2K | $78.75 | 2.10x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 1.2K | $130.7K | $111.98 | 1.41x |
| 99345 | New patient home visit, typically 75 minutes | 580 | $89.3K | $154.02 | 4.13x |
| 99344 | New patient home visit, typically 60 minutes | 674 | $85.6K | $127.00 | 4.27x |
| 99285 | Emergency department visit, problem with significant threat to life or function | 592 | $77.7K | $131.21 | 11.92x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 6.0K | $71.9K | $12.07 | 3.12x |
| 99348 | Established patient home visit, typically 25 minutes | 1.1K | $69.3K | $62.36 | 4.01x |
| G0318 | Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualif | 1.9K | $42.7K | $22.85 | 2.63x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 323 | $31.3K | $96.99 | 4.35x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 638 | $26.9K | $42.23 | 3.49x |
| 99205 | New patient outpatient visit, total time 60-74 minutes | 190 | $25.4K | $133.57 | 3.75x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 557 | $25.2K | $45.19 | 1.81x |
| 99284 | Emergency department visit, problem of high severity | 271 | $24.0K | $88.51 | 10.69x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 425 | $23.6K | $55.45 | 2.74x |
This provider submits charges 3.47 times higher than what Medicare actually pays.
A markup ratio of 3.47x means for every $100 Medicare pays, this provider initially charges $347. 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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