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 2117% from 2019 to 2023.
74% of their billing comes from a single procedure code (G0181 — Physician 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 development and/or revision of c).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 1964% 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 | $191.19 | $121.91 | 1.57x | $69.28 | $45.7K | 336 | 332 |
| 2020 | $175.23 | $110.35 | 1.59x | $64.88 | $943.1K | 11.3K | 6.1K |
| 2021 | $125.76 | $84.76 | 1.48x | $41.00 | $1.0M | 13.0K | 6.0K |
| 2022 | $130.89 | $83.41 | 1.57x | $47.48 | $1.2M | 15.2K | 7.3K |
| 2023 | $115.72 | $68.74 | 1.68x | $46.98 | $1.0M | 13.6K | 5.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| G0181 | Physician 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 development and/or revision of c | 34.0K | $3.1M | $91.17 | 1.66x |
| G0180 | Physician 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 to affirm the initial implem | 7.9K | $366.2K | $46.48 | 1.67x |
| G0179 | Physician 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 to affirm the initial imp | 7.3K | $266.5K | $36.54 | 1.67x |
| 99349 | Established patient home visit, typically 40 minutes | 1.1K | $125.0K | $109.95 | 1.68x |
| 99344 | New patient home visit, typically 60 minutes | 511 | $77.7K | $152.07 | 1.71x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 503 | $69.5K | $138.25 | 1.31x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 309 | $57.5K | $185.95 | 1.34x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 479 | $35.3K | $73.62 | 1.68x |
| 99345 | New patient home visit, typically 75 minutes | 172 | $31.8K | $184.71 | 1.77x |
| G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes | 603 | $29.4K | $48.74 | 1.68x |
| 99350 | Established patient home visit, typically 60 minutes | 111 | $17.0K | $153.05 | 1.72x |
| 99407 | Smoking and tobacco use intensive counseling, greater than 10 minutes | 120 | $3.7K | $31.18 | 1.34x |
| 99473 | Self-measured blood pressure; patient education/training and device calibration | 342 | $3.7K | $10.81 | 1.72x |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | 18 | $3.3K | $182.59 | 1.37x |
This provider submits charges 1.65 times higher than what Medicare actually pays.
A markup ratio of 1.65x means for every $100 Medicare pays, this provider initially charges $165. 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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