This provider's $4.4M in total Medicare payments ranks in the 99th percentile of Psychologist, Clinical providers nationally.
64% of their billing comes from a single procedure code (90791 — Psychiatric diagnostic evaluation).
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 | $249.00 | $90.57 | 2.75x | $158.43 | $433.6K | 4.8K | 2.8K |
| 2015 | $249.00 | $88.91 | 2.80x | $160.09 | $386.8K | 4.3K | 2.7K |
| 2016 | $249.00 | $87.72 | 2.84x | $161.28 | $458.5K | 5.3K | 3.1K |
| 2017 | $249.00 | $89.09 | 2.79x | $159.91 | $417.4K | 4.7K | 2.8K |
| 2018 | $265.50 | $90.67 | 2.93x | $174.83 | $411.9K | 4.6K | 2.7K |
| 2019 | $349.00 | $92.10 | 3.79x | $256.90 | $399.7K | 4.4K | 2.7K |
| 2020 | $319.20 | $94.74 | 3.37x | $224.46 | $406.4K | 4.4K | 2.9K |
| 2021 | $299.33 | $104.79 | 2.86x | $194.54 | $507.5K | 4.5K | 3.2K |
| 2022 | $262.00 | $94.13 | 2.78x | $167.87 | $497.5K | 3.8K | 3.1K |
| 2023 | $262.00 | $92.17 | 2.84x | $169.83 | $513.2K | 4.5K | 3.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | 23.2K | $2.8M | $121.38 | 2.94x |
| 90834 | Psychotherapy, 45 minutes with patient and/or family member | 20.6K | $1.5M | $73.72 | 3.20x |
| 90832 | Psychotherapy, 30 minutes | 1.4K | $82.3K | $60.36 | 2.49x |
| 90847 | Family psychotherapy including patient, 50 minutes | 153 | $13.3K | $86.95 | 2.30x |
This provider submits charges 3.02 times higher than what Medicare actually pays.
A markup ratio of 3.02x means for every $100 Medicare pays, this provider initially charges $302. 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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