This provider's $4.6M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 185% from 2014 to 2023.
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 | $181.10 | $97.23 | 1.86x | $83.87 | $242.6K | 2.7K | 1.9K |
| 2015 | $120.80 | $60.84 | 1.99x | $59.96 | $290.8K | 3.4K | 2.3K |
| 2016 | $170.35 | $91.81 | 1.86x | $78.54 | $432.6K | 5.1K | 3.0K |
| 2017 | $155.65 | $80.24 | 1.94x | $75.41 | $427.1K | 5.5K | 3.2K |
| 2018 | $158.28 | $82.18 | 1.93x | $76.10 | $444.1K | 5.5K | 3.3K |
| 2019 | $180.09 | $83.86 | 2.15x | $96.23 | $518.8K | 6.2K | 3.6K |
| 2020 | $158.89 | $79.49 | 2.00x | $79.40 | $477.6K | 5.8K | 3.2K |
| 2021 | $176.50 | $90.85 | 1.94x | $85.65 | $497.7K | 5.6K | 3.3K |
| 2022 | $226.83 | $90.75 | 2.50x | $136.08 | $566.2K | 7.1K | 3.6K |
| 2023 | $211.43 | $80.03 | 2.64x | $131.40 | $691.0K | 8.7K | 4.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 10.4K | $1.6M | $152.47 | 2.16x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 25.8K | $1.5M | $56.60 | 2.16x |
| 99239 | Hospital discharge day management, more than 30 minutes | 7.5K | $620.1K | $83.21 | 2.05x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 7.4K | $606.2K | $82.12 | 2.00x |
| 99220 | Hospital observation care typically 70 minutes per day | 838 | $120.8K | $144.11 | 1.78x |
| 99238 | Hospital discharge day management, 30 minutes or less | 959 | $53.2K | $55.44 | 2.33x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 1.3K | $41.1K | $30.66 | 2.10x |
| 99217 | Hospital observation care discharge | 494 | $27.9K | $56.52 | 1.90x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 247 | $20.0K | $80.89 | 2.04x |
| 99236 | Hospital observation or inpatient care high severity, 55 minutes per day | 102 | $17.5K | $171.42 | 1.90x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 86 | $10.4K | $120.98 | 2.08x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 100 | $10.3K | $102.51 | 2.63x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 55 | $2.9K | $53.23 | 2.07x |
| 99225 | Subsequent observation care, typically 25 minutes per day | 52 | $2.9K | $55.82 | 1.97x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 14 | $2.3K | $163.13 | 1.90x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 32 | $1.7K | $54.06 | 1.90x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 41 | $1.4K | $35.05 | 1.89x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 16 | $1.3K | $81.71 | 3.79x |
| 99226 | Subsequent observation care, typically 35 minutes per day | 14 | $1.2K | $83.73 | 1.43x |
| 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 imple | 28 | $1.2K | $41.74 | 2.40x |
This provider submits charges 2.11 times higher than what Medicare actually pays.
A markup ratio of 2.11x means for every $100 Medicare pays, this provider initially charges $211. 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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