This provider's $5.2M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 87% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 59% in 2015
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 | $198.10 | $75.74 | 2.62x | $122.36 | $336.7K | 5.4K | 2.0K |
| 2015 | $185.34 | $64.95 | 2.85x | $120.39 | $535.4K | 8.5K | 2.2K |
| 2016 | $194.21 | $70.43 | 2.76x | $123.78 | $529.3K | 8.8K | 2.6K |
| 2017 | $188.08 | $66.94 | 2.81x | $121.14 | $492.9K | 8.1K | 2.9K |
| 2018 | $192.22 | $72.12 | 2.67x | $120.10 | $514.9K | 7.6K | 2.8K |
| 2019 | $190.68 | $70.58 | 2.70x | $120.10 | $533.1K | 9.1K | 3.6K |
| 2020 | $174.11 | $64.77 | 2.69x | $109.34 | $460.1K | 8.1K | 2.6K |
| 2021 | $181.92 | $70.34 | 2.59x | $111.58 | $507.2K | 8.7K | 2.6K |
| 2022 | $177.50 | $68.19 | 2.60x | $109.31 | $655.7K | 12.7K | 3.4K |
| 2023 | $176.75 | $65.05 | 2.72x | $111.70 | $629.2K | 12.5K | 4.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 19.7K | $1.3M | $64.10 | 2.50x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 10.5K | $1.0M | $99.76 | 2.00x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 4.1K | $380.3K | $92.90 | 1.88x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 11.7K | $364.7K | $31.26 | 4.32x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 4.1K | $346.1K | $85.34 | 2.64x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.9K | $343.1K | $69.80 | 2.15x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 4.8K | $225.5K | $46.77 | 4.49x |
| 94729 | Measurement of lung diffusing capacity | 3.7K | $193.5K | $52.98 | 3.96x |
| 87811 | Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) | 3.4K | $138.9K | $40.65 | 1.84x |
| 94727 | Determination of lung volumes using gas dilution or washout | 3.4K | $135.7K | $39.88 | 5.02x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.6K | $103.3K | $65.81 | 2.28x |
| 94664 | Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | 6.2K | $102.1K | $16.38 | 3.66x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 652 | $95.1K | $145.87 | 2.06x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 461 | $84.8K | $183.90 | 2.04x |
| 94618 | Test for exercise-induced lung stress | 2.5K | $76.5K | $31.13 | 9.16x |
| 94640 | Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen | 3.7K | $46.8K | $12.72 | 4.72x |
| 95831 | Manual muscle testing of arm, leg or trunk | 1.4K | $40.4K | $28.96 | 3.11x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 392 | $36.9K | $94.15 | 2.16x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 343 | $33.2K | $96.87 | 2.58x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 256 | $30.6K | $119.34 | 2.30x |
This provider submits charges 2.79 times higher than what Medicare actually pays.
A markup ratio of 2.79x means for every $100 Medicare pays, this provider initially charges $279. 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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