This provider's $6.1M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 571% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 68% 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 | $168.93 | $84.86 | 1.99x | $84.07 | $180.9K | 2.2K | 1.7K |
| 2015 | $166.68 | $87.11 | 1.91x | $79.57 | $304.7K | 3.7K | 1.9K |
| 2016 | $192.47 | $102.70 | 1.87x | $89.77 | $356.0K | 4.2K | 1.6K |
| 2017 | $135.98 | $79.58 | 1.71x | $56.40 | $415.2K | 5.5K | 2.6K |
| 2018 | $113.11 | $71.91 | 1.57x | $41.20 | $422.9K | 5.7K | 2.6K |
| 2019 | $117.31 | $69.43 | 1.69x | $47.88 | $525.3K | 6.8K | 3.5K |
| 2020 | $106.38 | $71.27 | 1.49x | $35.11 | $762.7K | 12.0K | 4.1K |
| 2021 | $101.04 | $65.03 | 1.55x | $36.01 | $804.6K | 13.8K | 5.2K |
| 2022 | $147.75 | $95.67 | 1.54x | $52.08 | $1.1M | 16.0K | 6.0K |
| 2023 | $121.88 | $79.78 | 1.53x | $42.10 | $1.2M | 18.4K | 5.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 23.2K | $1.8M | $78.32 | 1.49x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 22.9K | $982.2K | $42.96 | 1.51x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 6.3K | $584.0K | $92.48 | 1.52x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 3.3K | $466.6K | $141.23 | 1.51x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 3.3K | $378.8K | $115.44 | 1.50x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 3.3K | $288.6K | $86.28 | 1.65x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.2K | $197.3K | $166.52 | 1.54x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 2.7K | $153.8K | $56.51 | 1.56x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 3.4K | $147.0K | $42.64 | 1.85x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 1.3K | $143.6K | $108.71 | 1.54x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 2.4K | $141.5K | $60.04 | 1.67x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.1K | $131.5K | $63.04 | 1.60x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 900 | $117.3K | $130.34 | 1.64x |
| G0506 | Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) | 1.5K | $70.3K | $47.10 | 1.79x |
| 99439 | Chronic care management services, each additional 20 minutes of clinical staff time per calendar month | 1.7K | $67.8K | $39.47 | 1.38x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 1.5K | $65.7K | $43.50 | 1.34x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 640 | $42.5K | $66.45 | 1.35x |
| 99457 | Remote monitoring of physiologic parameters management services, 20 minutes or more of qualified health care professional time per calendar month | 738 | $31.9K | $43.16 | 1.57x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 252 | $31.7K | $125.99 | 1.48x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 135 | $24.9K | $184.31 | 2.31x |
This provider submits charges 1.54 times higher than what Medicare actually pays.
A markup ratio of 1.54x means for every $100 Medicare pays, this provider initially charges $154. This is lower 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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