This provider's $5.3M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 75% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 98% in 2022
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 | $191.55 | $106.81 | 1.79x | $84.74 | $383.3K | 4.4K | 1.2K |
| 2015 | $169.08 | $108.85 | 1.55x | $60.23 | $451.9K | 4.1K | 1.6K |
| 2016 | $172.88 | $114.16 | 1.51x | $58.72 | $501.3K | 4.3K | 998 |
| 2017 | $181.67 | $112.99 | 1.61x | $68.68 | $573.4K | 4.7K | 668 |
| 2018 | $188.75 | $129.26 | 1.46x | $59.49 | $607.3K | 4.7K | 604 |
| 2019 | $195.00 | $137.67 | 1.42x | $57.33 | $546.7K | 4.2K | 528 |
| 2020 | $206.67 | $136.59 | 1.51x | $70.08 | $533.9K | 4.1K | 599 |
| 2021 | $210.20 | $125.87 | 1.67x | $84.33 | $353.1K | 2.9K | 470 |
| 2022 | $222.41 | $129.67 | 1.72x | $92.74 | $697.9K | 6.6K | 323 |
| 2023 | $210.53 | $122.52 | 1.72x | $88.01 | $669.4K | 6.5K | 311 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99337 | Established patient assisted living visit, typically 60 minutes | 14.6K | $2.2M | $152.08 | 1.64x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 11.7K | $857.6K | $73.31 | 1.39x |
| 99350 | Established patient home visit, typically 60 minutes | 3.9K | $567.1K | $147.15 | 1.46x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 1.4K | $272.8K | $193.32 | 1.91x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 2.0K | $222.4K | $112.68 | 1.41x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 1.6K | $217.7K | $132.48 | 1.38x |
| 99354 | Prolonged outpatient service, first hour | 1.6K | $167.9K | $107.50 | 1.40x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 682 | $131.7K | $193.06 | 1.36x |
| 99356 | Prolonged inpatient or observation hospital service, first hour | 1.6K | $116.2K | $74.70 | 2.01x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.9K | $110.0K | $57.34 | 2.09x |
| 99292 | Critical care delivery critically ill or injured patient | 872 | $81.6K | $93.55 | 2.57x |
| 99316 | Nursing facility discharge management, more than 30 minutes | 845 | $70.2K | $83.13 | 1.51x |
| 99328 | New patient assisted living visit, typically 75 minutes | 421 | $69.1K | $164.15 | 1.52x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 297 | $45.6K | $153.56 | 2.47x |
| 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 | 1.5K | $39.3K | $25.70 | 1.95x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 250 | $21.0K | $83.85 | 2.15x |
| 99345 | New patient home visit, typically 75 minutes | 109 | $18.2K | $167.22 | 1.49x |
| 99355 | Prolonged outpatient service, each additional 30 minutes | 206 | $16.4K | $79.82 | 1.88x |
| 99336 | Established patient assisted living visit, typically 40 minutes | 162 | $16.2K | $99.73 | 1.50x |
| 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 | 329 | $14.2K | $43.03 | 1.74x |
This provider submits charges 1.6 times higher than what Medicare actually pays.
A markup ratio of 1.6x means for every $100 Medicare pays, this provider initially charges $160. 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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