This provider's $4.0M in total Medicare payments ranks in the 99th percentile of Infectious Disease providers nationally.
Medicare payments to this provider grew 54% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
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 | $229.83 | $90.92 | 2.53x | $138.91 | $350.5K | 4.4K | 1.9K |
| 2015 | $268.49 | $95.36 | 2.82x | $173.13 | $369.0K | 4.5K | 2.0K |
| 2016 | $305.18 | $98.37 | 3.10x | $206.81 | $429.0K | 5.1K | 2.2K |
| 2017 | $271.89 | $114.76 | 2.37x | $157.13 | $441.8K | 4.1K | 1.9K |
| 2018 | $303.37 | $99.57 | 3.05x | $203.80 | $345.1K | 4.1K | 2.0K |
| 2019 | $283.56 | $93.51 | 3.03x | $190.05 | $371.9K | 4.3K | 2.0K |
| 2020 | $286.90 | $98.73 | 2.91x | $188.17 | $361.2K | 4.2K | 1.7K |
| 2021 | $324.91 | $101.88 | 3.19x | $223.03 | $361.9K | 4.1K | 1.8K |
| 2022 | $445.25 | $104.09 | 4.28x | $341.16 | $384.0K | 4.4K | 2.0K |
| 2023 | $438.46 | $99.97 | 4.39x | $338.49 | $540.3K | 6.1K | 2.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 26.5K | $1.8M | $68.78 | 3.44x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 6.7K | $863.8K | $128.83 | 3.44x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 4.9K | $489.3K | $99.82 | 3.44x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 2.2K | $416.2K | $187.24 | 3.38x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 2.7K | $166.8K | $61.49 | 1.32x |
| G0181 | Physician 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 development and/or revision of c | 619 | $62.5K | $100.90 | 3.23x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 222 | $26.0K | $117.31 | 1.29x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 186 | $19.3K | $103.95 | 2.93x |
| 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 | 347 | $17.8K | $51.39 | 9.73x |
| 99239 | Hospital discharge day management, more than 30 minutes | 163 | $17.3K | $106.23 | 4.20x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 78 | $11.8K | $151.76 | 3.32x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 131 | $10.0K | $76.57 | 3.26x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 97 | $8.0K | $82.97 | 1.29x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 73 | $6.8K | $92.59 | 3.43x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 171 | $6.2K | $36.00 | 4.21x |
| 99318 | Nursing facility annual assessment, typically 30 minutes | 68 | $5.5K | $81.13 | 1.35x |
| 99358 | Prolonged patient service without direct patient contact first hour | 25 | $2.4K | $96.46 | 4.04x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 16 | $2.1K | $129.65 | 1.93x |
This provider submits charges 3.35 times higher than what Medicare actually pays.
A markup ratio of 3.35x means for every $100 Medicare pays, this provider initially charges $335. 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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