This provider's $3.4M in total Medicare payments ranks in the 99th percentile of Emergency Medicine providers nationally.
Medicare payments to this provider grew 2126% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 732% 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 |
|---|---|---|---|---|---|---|---|
| 2014 | $1.1K | $102.24 | 11.09x | $1.0K | $66.5K | 634 | 618 |
| 2015 | $1.6K | $126.98 | 12.42x | $1.4K | $88.3K | 800 | 785 |
| 2016 | $384.43 | $43.42 | 8.85x | $341.01 | $63.0K | 1.4K | 1.4K |
| 2017 | $216.93 | $26.26 | 8.26x | $190.67 | $63.0K | 1.9K | 1.8K |
| 2018 | $239.83 | $26.14 | 9.17x | $213.69 | $63.7K | 2.1K | 1.8K |
| 2019 | $221.84 | $22.58 | 9.82x | $199.26 | $57.7K | 1.8K | 1.7K |
| 2020 | $189.63 | $25.43 | 7.46x | $164.20 | $45.6K | 1.5K | 1.3K |
| 2021 | $128.06 | $49.88 | 2.57x | $78.18 | $379.5K | 5.8K | 4.9K |
| 2022 | $104.73 | $70.50 | 1.49x | $34.23 | $1.1M | 14.5K | 11.8K |
| 2023 | $109.75 | $72.66 | 1.51x | $37.09 | $1.5M | 18.2K | 8.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 11.0K | $1.0M | $91.06 | 1.75x |
| 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 | 4.0K | $394.7K | $99.05 | 1.53x |
| 99443 | Physician telephone patient service, 21-30 minutes of medical discussion | 2.8K | $272.8K | $97.10 | 1.52x |
| 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 | 4.0K | $210.6K | $53.25 | 1.50x |
| 99358 | Prolonged patient service without direct patient contact first hour | 2.5K | $210.2K | $83.69 | 1.52x |
| 99349 | Established patient home visit, typically 40 minutes | 2.0K | $192.3K | $96.22 | 1.53x |
| G0181 | Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow | 1.9K | $155.8K | $80.66 | 1.50x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 1.8K | $119.7K | $67.91 | 1.53x |
| 99285 | Emergency department visit, problem with significant threat to life or function | 724 | $91.5K | $126.43 | 10.81x |
| G0180 | Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and | 2.3K | $89.4K | $39.51 | 1.53x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 640 | $74.2K | $115.95 | 2.32x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.2K | $74.0K | $62.27 | 1.88x |
| 99284 | Emergency department visit, problem of high severity | 750 | $61.8K | $82.45 | 12.55x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 431 | $54.3K | $125.88 | 1.19x |
| G0179 | Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians a | 1.7K | $51.2K | $30.38 | 1.53x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 947 | $44.1K | $46.59 | 1.56x |
| 99497 | Advance care planning, first 30 minutes | 396 | $31.6K | $79.72 | 1.23x |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 660 | $28.1K | $42.56 | 1.51x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 381 | $25.3K | $66.45 | 3.90x |
| 99441 | Physician telephone patient service, 5-10 minutes of medical discussion | 620 | $25.2K | $40.59 | 1.57x |
This provider submits charges 2.42 times higher than what Medicare actually pays.
A markup ratio of 2.42x means for every $100 Medicare pays, this provider initially charges $242. 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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