This provider's $6.1M in total Medicare payments ranks in the 99th percentile of Certified Clinical Nurse Specialist providers nationally.
Medicare payments to this provider grew 144946% from 2015 to 2023.
91% of their billing comes from a single procedure code (Q4217 — Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 3994% 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 |
|---|---|---|---|---|---|---|---|
| 2015 | $40.64 | $15.31 | 2.65x | $25.33 | $3.5K | 230 | 2 |
| 2017 | $190.34 | $103.32 | 1.84x | $87.02 | $29.9K | 289 | 4 |
| 2018 | $85.00 | $32.88 | 2.59x | $52.12 | $4.8K | 147 | 1 |
| 2019 | $85.00 | $33.57 | 2.53x | $51.43 | $11.6K | 346 | 1 |
| 2020 | $85.00 | $31.05 | 2.74x | $53.95 | $3.5K | 113 | 1 |
| 2021 | $292.03 | $94.59 | 3.09x | $197.44 | $143.7K | 1.5K | 7 |
| 2022 | $457.64 | $218.19 | 2.10x | $239.45 | $828.5K | 3.8K | 11 |
| 2023 | $1.2K | $895.08 | 1.33x | $295.65 | $5.1M | 5.7K | 7 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| Q4217 | Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter | 5.4K | $5.6M | $1.0K | 1.32x |
| 99350 | Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes | 1.9K | $217.7K | $117.12 | 3.13x |
| 99354 | Extended office or other outpatient service, first hour | 1.2K | $97.7K | $84.87 | 3.09x |
| 11042 | Removal of skin and tissue, 20.0 sq cm or less | 831 | $69.0K | $83.05 | 3.18x |
| 99358 | Extended patient service without direct patient contact, first hour | 578 | $42.2K | $72.95 | 3.18x |
| 99213 | Established patient outpatient visit, total time 20-29 minutes | 637 | $21.4K | $33.58 | 2.53x |
| 99345 | Residence visit for new patient with high level of medical decision making, per day, if using time, at least 75 minutes | 114 | $15.3K | $134.32 | 3.21x |
| 15271 | Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less | 155 | $14.7K | $94.84 | 3.42x |
| G0318 | Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualif | 710 | $14.3K | $20.15 | 4.54x |
| 99344 | New patient home visit, typically 1 hour | 100 | $11.6K | $115.66 | 3.20x |
| 99310 | Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes | 84 | $7.9K | $93.86 | 3.34x |
| 99355 | Extended office or other outpatient service, each additional 30 minutes | 109 | $6.9K | $63.34 | 3.25x |
| 99349 | Established patient home visit, typically 40 minutes | 53 | $4.5K | $84.51 | 2.00x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 217 | $3.5K | $15.92 | 2.64x |
| 99356 | Prolonged inpatient or observation hospital service, first hour | 33 | $2.0K | $61.62 | 3.13x |
| 99306 | Initial nursing facility visit per day, typically 45 minutes | 18 | $1.9K | $107.67 | 3.72x |
| 11045 | Removal of skin and tissue, each additional 20.0 sq cm or less | 59 | $1.6K | $26.96 | 3.30x |
| 11719 | Trimming of fingernails or toenails | 13 | $67.49 | $5.19 | 3.47x |
This provider submits charges 1.48 times higher than what Medicare actually pays.
A markup ratio of 1.48x means for every $100 Medicare pays, this provider initially charges $148. 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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