This provider's $4.2M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 429% from 2019 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 123% in 2020
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 |
|---|---|---|---|---|---|---|---|
| 2019 | $311.09 | $91.87 | 3.39x | $219.22 | $264.9K | 2.6K | 1.1K |
| 2020 | $307.55 | $89.59 | 3.43x | $217.96 | $592.0K | 6.6K | 2.8K |
| 2021 | $302.10 | $87.98 | 3.43x | $214.12 | $971.2K | 11.0K | 4.8K |
| 2022 | $335.42 | $96.95 | 3.46x | $238.47 | $991.1K | 10.5K | 4.8K |
| 2023 | $374.66 | $115.74 | 3.24x | $258.92 | $1.4M | 12.7K | 5.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 11043 | Removal of skin and/or muscle first 20 sq cm or less | 7.1K | $1.1M | $156.88 | 3.76x |
| 11042 | Removal of skin and tissue first 20 sq cm or less | 9.6K | $673.4K | $70.38 | 4.77x |
| 11044 | Removal of skin and bone first 20 sq cm or less | 2.0K | $477.5K | $233.26 | 3.38x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 7.9K | $449.1K | $56.57 | 2.97x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 4.4K | $336.1K | $76.65 | 2.98x |
| 97607 | Therapy procedure using a special bandage, vacuum pump and disposable medical equipment, surface area 50.0 sq cm or less | 679 | $192.6K | $283.69 | 3.62x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 1.2K | $135.3K | $113.80 | 2.96x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 973 | $132.5K | $136.22 | 2.96x |
| Q4262 | Dual layer impax membrane, per square centimeter | 153 | $132.2K | $863.79 | 2.56x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 1.2K | $121.1K | $104.23 | 2.95x |
| 17250 | Application of chemical agent to excessive wound tissue | 2.6K | $94.3K | $36.71 | 6.35x |
| 99304 | Initial nursing facility visit, typically 25 minutes per day | 1.1K | $75.9K | $70.10 | 2.96x |
| 99350 | Established patient home visit, typically 60 minutes | 396 | $57.4K | $144.91 | 2.92x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 1.5K | $50.8K | $33.68 | 2.98x |
| 97597 | Removal of tissue from wound, 20.0 sq cm or less | 476 | $37.6K | $78.92 | 3.15x |
| 11046 | Removal of skin and/or muscle | 624 | $33.8K | $54.14 | 3.53x |
| 11047 | Removal of skin and bone | 360 | $33.0K | $91.76 | 3.47x |
| 99349 | Established patient home visit, typically 40 minutes | 231 | $24.0K | $103.79 | 2.92x |
| 15271 | Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less | 125 | $14.1K | $112.73 | 3.51x |
| 11045 | Removal of skin and tissue | 465 | $12.8K | $27.58 | 3.83x |
This provider submits charges 3.62 times higher than what Medicare actually pays.
A markup ratio of 3.62x means for every $100 Medicare pays, this provider initially charges $362. 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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