This provider's $4.0M in total Medicare payments ranks in the 98th percentile of Pain Management providers nationally.
Medicare payments to this provider grew 1344% from 2015 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 222% in 2016
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 |
|---|---|---|---|---|---|---|---|
| 2015 | $270.92 | $99.60 | 2.72x | $171.32 | $53.5K | 670 | 494 |
| 2016 | $297.85 | $72.09 | 4.13x | $225.76 | $172.1K | 2.6K | 1.2K |
| 2017 | $482.77 | $73.00 | 6.61x | $409.77 | $205.6K | 3.2K | 1.4K |
| 2018 | $424.06 | $76.44 | 5.55x | $347.62 | $245.7K | 3.8K | 1.7K |
| 2019 | $204.56 | $75.23 | 2.72x | $129.33 | $472.8K | 6.9K | 2.9K |
| 2020 | $207.79 | $78.59 | 2.64x | $129.20 | $647.3K | 7.9K | 3.3K |
| 2021 | $184.35 | $67.45 | 2.73x | $116.90 | $803.6K | 11.0K | 4.4K |
| 2022 | $169.50 | $64.16 | 2.64x | $105.34 | $648.0K | 9.3K | 4.2K |
| 2023 | $198.15 | $78.37 | 2.53x | $119.78 | $772.2K | 10.5K | 5.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 18.1K | $1.4M | $74.99 | 2.59x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 14.8K | $805.4K | $54.48 | 2.59x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 4.2K | $564.6K | $135.07 | 2.55x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 4.2K | $433.2K | $104.29 | 2.57x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.3K | $170.3K | $73.21 | 2.92x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time per calendar month | 3.0K | $127.0K | $42.75 | 2.25x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.8K | $91.0K | $51.41 | 2.87x |
| 99487 | Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month | 562 | $61.5K | $109.37 | 2.42x |
| G0506 | Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) | 1.3K | $47.1K | $36.92 | 3.61x |
| 99439 | Chronic care management services, each additional 20 minutes of clinical staff time per calendar month | 1.1K | $34.9K | $32.69 | 2.55x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 306 | $33.1K | $108.11 | 2.84x |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 227 | $32.7K | $143.84 | 3.06x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 514 | $32.5K | $63.17 | 2.50x |
| 99489 | Complex chronic care management services for two or more chronic conditions, each additional 60 minutes of clinical staff time directed by health care professional, per calendar month | 560 | $32.4K | $57.94 | 2.42x |
| 64483 | Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance | 214 | $31.3K | $146.37 | 8.46x |
| 99497 | Advance care planning, first 30 minutes | 480 | $29.8K | $62.11 | 2.96x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 227 | $26.2K | $115.47 | 2.83x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 467 | $15.9K | $34.08 | 2.51x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 325 | $14.4K | $44.23 | 4.34x |
| 80307 | Testing for presence of drug | 148 | $10.9K | $73.34 | 4.09x |
This provider submits charges 2.71 times higher than what Medicare actually pays.
A markup ratio of 2.71x means for every $100 Medicare pays, this provider initially charges $271. 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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