This provider's $6.1M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 180% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 77% 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 |
|---|---|---|---|---|---|---|---|
| 2014 | $94.09 | $69.97 | 1.34x | $24.12 | $441.0K | 5.1K | 2.3K |
| 2015 | $96.55 | $73.41 | 1.32x | $23.14 | $525.2K | 5.8K | 2.7K |
| 2016 | $140.15 | $86.69 | 1.62x | $53.46 | $482.6K | 5.8K | 3.3K |
| 2017 | $132.46 | $76.21 | 1.74x | $56.25 | $451.8K | 6.2K | 3.1K |
| 2018 | $186.56 | $75.89 | 2.46x | $110.67 | $444.6K | 6.0K | 3.1K |
| 2019 | $169.01 | $69.10 | 2.45x | $99.91 | $442.4K | 6.4K | 3.3K |
| 2020 | $175.64 | $71.29 | 2.46x | $104.35 | $418.4K | 5.9K | 3.3K |
| 2021 | $158.28 | $67.41 | 2.35x | $90.87 | $741.9K | 9.9K | 6.3K |
| 2022 | $168.56 | $67.04 | 2.51x | $101.52 | $914.0K | 12.7K | 7.9K |
| 2023 | $162.17 | $61.51 | 2.64x | $100.66 | $1.2M | 19.3K | 10.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 24.5K | $2.2M | $88.05 | 2.49x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 8.2K | $690.5K | $84.38 | 2.06x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 3.0K | $527.3K | $177.37 | 1.80x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 2.9K | $388.6K | $132.91 | 1.98x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.7K | $264.6K | $157.02 | 2.02x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 2.5K | $212.2K | $83.91 | 2.12x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 3.4K | $171.9K | $50.19 | 2.62x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 2.9K | $168.3K | $58.39 | 2.48x |
| 99239 | Hospital discharge day management, more than 30 minutes | 1.6K | $143.4K | $87.48 | 2.09x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 881 | $100.9K | $114.52 | 2.40x |
| G0514 | Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code | 1.4K | $91.9K | $65.49 | 2.10x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 862 | $88.2K | $102.34 | 1.75x |
| G0513 | Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preve | 1.3K | $84.1K | $65.58 | 2.09x |
| 99457 | Remote physiologic monitoring treatment management services, health care professional time in a calendar month requiring interactive communication with the patient/caregiver; first 20 minutes | 2.0K | $81.7K | $40.28 | 2.60x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 1.5K | $69.8K | $45.98 | 2.64x |
| G0446 | Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes | 2.5K | $67.2K | $27.14 | 2.08x |
| 90670 | Pneumococcal vaccine for injection into muscle | 303 | $62.7K | $206.90 | 1.57x |
| 99491 | Chronic care management services for two or more chronic conditions, first 30 minutes provided personally by health care professional, per calendar month | 855 | $58.7K | $68.66 | 2.33x |
| G0444 | Annual depression screening, 15 minutes | 2.6K | $49.9K | $19.41 | 2.06x |
| 99238 | Hospital discharge day management, 30 minutes or less | 850 | $49.0K | $57.62 | 2.09x |
This provider submits charges 2.25 times higher than what Medicare actually pays.
A markup ratio of 2.25x means for every $100 Medicare pays, this provider initially charges $225. 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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