This provider's $3.7M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
Their average markup ratio of 5.35x is significantly above the specialty median of 2.9x.
Medicare payments to this provider grew 352% from 2020 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 174% 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 |
|---|---|---|---|---|---|---|---|
| 2020 | $418.67 | $112.12 | 3.73x | $306.55 | $331.9K | 3.5K | 1.3K |
| 2021 | $924.96 | $131.44 | 7.04x | $793.52 | $909.7K | 10.9K | 3.4K |
| 2022 | $1.1K | $124.27 | 8.80x | $969.46 | $976.0K | 11.8K | 4.1K |
| 2023 | $1.1K | $126.80 | 8.45x | $944.81 | $1.5M | 17.9K | 6.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 24.7K | $1.7M | $69.05 | 5.70x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 3.6K | $439.5K | $123.64 | 4.81x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 3.8K | $383.2K | $99.83 | 4.87x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 4.3K | $283.9K | $66.28 | 3.00x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 1.6K | $192.0K | $120.02 | 2.08x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 2.4K | $169.1K | $71.63 | 6.02x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 782 | $138.2K | $176.74 | 3.89x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 649 | $136.3K | $209.99 | 3.15x |
| 43246 | Insertion of stomach tube using an endoscope | 262 | $51.4K | $196.17 | 11.46x |
| 99214 | Established patient outpatient visit, total time 30-39 minutes | 432 | $49.9K | $115.53 | 2.13x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 555 | $34.1K | $61.47 | 37.21x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 98 | $25.6K | $261.14 | 1.89x |
| 99213 | Established patient outpatient visit, total time 20-29 minutes | 236 | $19.7K | $83.63 | 2.21x |
| 45380 | Biopsy of the large bowel using an endoscope (colonoscopy) | 110 | $16.0K | $145.79 | 22.98x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 97 | $14.9K | $153.38 | 2.13x |
| 99204 | New patient outpatient visit, total time 45-59 minutes | 66 | $9.5K | $144.43 | 2.42x |
| 45385 | Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare | 37 | $8.3K | $224.37 | 16.32x |
| 43255 | Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope | 47 | $8.0K | $169.34 | 15.80x |
| 43762 | Replacement of stomach stoma tube accessed through skin | 210 | $7.8K | $37.16 | 8.07x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 36 | $5.6K | $156.71 | 1.91x |
This provider submits charges 5.35 times higher than what Medicare actually pays.
A markup ratio of 5.35x means for every $100 Medicare pays, this provider initially charges $535. 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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