This provider's $3.4M in total Medicare payments ranks in the 99th percentile of Psychiatry providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
AI-generated analysis based on Medicare payment data.
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 | $197.42 | $72.01 | 2.74x | $125.41 | $413.6K | 6.8K | 1.7K |
| 2015 | $167.23 | $70.93 | 2.36x | $96.30 | $346.6K | 5.6K | 1.7K |
| 2016 | $137.60 | $64.31 | 2.14x | $73.29 | $281.4K | 4.6K | 1.4K |
| 2017 | $186.38 | $78.65 | 2.37x | $107.73 | $383.8K | 6.8K | 1.9K |
| 2018 | $173.19 | $79.30 | 2.18x | $93.89 | $346.4K | 6.8K | 1.8K |
| 2019 | $159.51 | $71.39 | 2.23x | $88.12 | $287.4K | 5.9K | 1.5K |
| 2020 | $146.67 | $74.45 | 1.97x | $72.22 | $352.4K | 6.9K | 1.6K |
| 2021 | $146.67 | $79.97 | 1.83x | $66.70 | $342.9K | 6.9K | 1.5K |
| 2022 | $162.00 | $82.98 | 1.95x | $79.02 | $327.1K | 6.8K | 1.4K |
| 2023 | $162.00 | $84.58 | 1.92x | $77.42 | $366.5K | 7.0K | 1.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 31.4K | $1.0M | $32.12 | 2.78x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 15.9K | $905.6K | $57.03 | 1.82x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 3.5K | $542.1K | $156.62 | 1.66x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 6.4K | $529.7K | $82.40 | 1.71x |
| 99239 | Hospital discharge day management, more than 30 minutes | 2.5K | $212.6K | $84.51 | 1.84x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.0K | $138.5K | $46.49 | 3.12x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 544 | $42.9K | $78.80 | 4.49x |
| 90791 | Psychiatric diagnostic evaluation | 407 | $39.5K | $97.15 | 2.46x |
| 99220 | Hospital observation care typically 70 minutes per day | 53 | $7.6K | $143.61 | 2.51x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 309 | $6.2K | $20.21 | 6.13x |
| 99219 | Hospital observation care typically 50 minutes | 48 | $5.0K | $104.76 | 2.63x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 82 | $4.3K | $52.49 | 2.38x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 26 | $1.6K | $60.78 | 2.51x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 14 | $1.5K | $108.27 | 1.67x |
| 99218 | Hospital observation care typically 30 minutes | 18 | $1.4K | $76.89 | 2.93x |
| 99217 | Hospital observation care discharge | 14 | $788.20 | $56.30 | 4.88x |
This provider submits charges 2.17 times higher than what Medicare actually pays.
A markup ratio of 2.17x means for every $100 Medicare pays, this provider initially charges $217. 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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