This provider's $3.2M in total Medicare payments ranks in the 99th percentile of Nurse Practitioner providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 171% 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 |
|---|---|---|---|---|---|---|---|
| 2016 | $189.24 | $89.57 | 2.11x | $99.67 | $371.6K | 3.5K | 2.3K |
| 2017 | $203.74 | $95.61 | 2.13x | $108.13 | $537.8K | 5.5K | 3.0K |
| 2018 | $189.72 | $93.18 | 2.04x | $96.54 | $566.7K | 6.2K | 3.1K |
| 2019 | $187.63 | $92.22 | 2.03x | $95.41 | $361.7K | 4.1K | 1.9K |
| 2021 | $205.57 | $94.24 | 2.18x | $111.33 | $229.5K | 2.7K | 1.1K |
| 2022 | $212.71 | $88.95 | 2.39x | $123.76 | $621.6K | 6.8K | 1.6K |
| 2023 | $160.86 | $70.61 | 2.28x | $90.25 | $529.1K | 8.0K | 1.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99350 | Established patient home visit, typically 60 minutes | 11.7K | $1.4M | $117.09 | 2.42x |
| 99349 | Established patient home visit, typically 40 minutes | 6.8K | $573.2K | $84.30 | 2.22x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 5.7K | $323.4K | $56.64 | 1.95x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 1.2K | $167.2K | $144.68 | 1.76x |
| 99344 | New patient home visit, typically 60 minutes | 1.4K | $158.0K | $114.63 | 2.24x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 1.2K | $119.6K | $101.44 | 1.68x |
| G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes | 2.6K | $110.6K | $42.19 | 1.87x |
| 99215 | Established patient outpatient visit, total time 40-54 minutes | 819 | $78.8K | $96.17 | 3.63x |
| 99345 | New patient home visit, typically 75 minutes | 481 | $67.2K | $139.68 | 2.42x |
| 99348 | Established patient home visit, typically 25 minutes | 1.3K | $67.1K | $53.60 | 2.43x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time per calendar month | 885 | $31.8K | $35.94 | 2.28x |
| 99337 | Established patient assisted living visit, typically 60 minutes | 238 | $30.4K | $127.54 | 2.17x |
| 99407 | Smoking and tobacco use intensive counseling, greater than 10 minutes | 1.1K | $26.2K | $23.30 | 1.73x |
| 99443 | Physician telephone patient service, 21-30 minutes of medical discussion | 330 | $25.8K | $78.31 | 2.32x |
| 99354 | Prolonged office or other outpatient service first hour | 275 | $19.4K | $70.59 | 2.29x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 126 | $10.5K | $83.51 | 1.85x |
| G0181 | Physician or allowed practitioner 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 or allow | 134 | $9.6K | $72.00 | 2.91x |
| 99336 | Established patient assisted living visit, typically 40 minutes | 89 | $7.7K | $86.85 | 2.21x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 32 | $6.1K | $190.86 | 2.00x |
| 99495 | Transitional care management services for problem of at least moderate complexity | 37 | $4.1K | $110.98 | 1.31x |
This provider submits charges 2.26 times higher than what Medicare actually pays.
A markup ratio of 2.26x means for every $100 Medicare pays, this provider initially charges $226. 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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