⚠️ This provider averages 265 services per working day — physically unusual for an individual practitioner
Based on 662.8K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $17.3M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 265 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 222% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 77% in 2016
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 | $60.37 | $31.30 | 1.93x | $29.07 | $905.7K | 28.9K | 24 |
| 2015 | $55.37 | $30.69 | 1.80x | $24.68 | $840.8K | 27.4K | 28 |
| 2016 | $58.47 | $32.87 | 1.78x | $25.60 | $1.5M | 45.2K | 32 |
| 2017 | $56.55 | $27.98 | 2.02x | $28.57 | $1.5M | 55.4K | 28 |
| 2018 | $65.94 | $33.28 | 1.98x | $32.66 | $2.0M | 60.0K | 29 |
| 2019 | $65.53 | $28.67 | 2.29x | $36.86 | $1.7M | 59.5K | 26 |
| 2020 | $85.14 | $30.35 | 2.81x | $54.79 | $1.9M | 61.9K | 30 |
| 2021 | $77.90 | $24.97 | 3.12x | $52.93 | $1.8M | 70.3K | 29 |
| 2022 | $65.19 | $20.11 | 3.24x | $45.08 | $2.3M | 114.0K | 33 |
| 2023 | $64.58 | $20.80 | 3.10x | $43.78 | $2.9M | 140.2K | 34 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0129 | Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 127.2K | $4.5M | $35.52 | 2.31x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 242.4K | $3.7M | $15.13 | 2.83x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 58.1K | $2.8M | $48.96 | 2.66x |
| J9312 | Injection, rituximab, 10 mg | 18.8K | $1.3M | $70.01 | 2.72x |
| J0897 | Injection, denosumab, 1 mg | 70.7K | $1.2M | $16.56 | 2.23x |
| J3380 | Injection, vedolizumab, 1 mg | 57.6K | $997.1K | $17.31 | 2.47x |
| J9310 | Injection, rituximab, 100 mg | 1.0K | $657.6K | $631.10 | 1.62x |
| J2350 | Injection, ocrelizumab, 1 mg | 9.0K | $424.2K | $47.09 | 2.86x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 5.2K | $396.2K | $75.87 | 2.46x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 5.5K | $259.1K | $47.37 | 2.53x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 2.2K | $203.8K | $91.56 | 3.27x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 4.1K | $193.3K | $47.10 | 3.27x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.1K | $121.6K | $108.68 | 2.55x |
| 80053 | Blood test, comprehensive group of blood chemicals | 9.9K | $118.2K | $11.99 | 2.61x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 10.4K | $94.1K | $9.01 | 2.59x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 3.4K | $68.4K | $20.30 | 3.42x |
| 36415 | Insertion of needle into vein for collection of blood sample | 11.4K | $39.5K | $3.45 | 2.90x |
| 85652 | Red blood cell sedimentation rate, to detect inflammation, automated | 10.6K | $33.6K | $3.16 | 2.54x |
| 90662 | Influenza vaccine split virus, preservative free | 609 | $29.9K | $49.10 | 1.43x |
| 96372 | Injection of drug or substance under skin or into muscle | 2.3K | $25.7K | $11.42 | 3.68x |
This provider submits charges 2.55 times higher than what Medicare actually pays.
A markup ratio of 2.55x means for every $100 Medicare pays, this provider initially charges $255. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
Other Rheumatology providers in MO for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Michael Joseph, MD | Joplin, MO | $40.7M | ✓ Clear |
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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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