This provider's $5.1M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 211% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 58% 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 | $105.61 | $68.61 | 1.54x | $37.00 | $295.8K | 4.3K | 2.2K |
| 2015 | $109.88 | $72.07 | 1.52x | $37.81 | $356.1K | 4.6K | 2.7K |
| 2016 | $134.43 | $75.58 | 1.78x | $58.85 | $305.7K | 4.1K | 2.2K |
| 2017 | $123.43 | $73.11 | 1.69x | $50.32 | $268.8K | 3.4K | 1.9K |
| 2018 | $109.67 | $73.80 | 1.49x | $35.87 | $340.4K | 4.4K | 2.5K |
| 2019 | $124.35 | $86.40 | 1.44x | $37.95 | $423.6K | 4.8K | 2.7K |
| 2020 | $124.67 | $86.93 | 1.43x | $37.74 | $554.5K | 5.8K | 2.3K |
| 2021 | $117.69 | $76.09 | 1.55x | $41.60 | $876.5K | 10.4K | 4.9K |
| 2022 | $103.56 | $67.96 | 1.52x | $35.60 | $741.0K | 9.4K | 4.1K |
| 2023 | $121.42 | $80.20 | 1.51x | $41.22 | $921.0K | 12.6K | 4.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 12.9K | $1.2M | $96.87 | 1.40x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 3.7K | $669.4K | $178.64 | 1.47x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 9.3K | $612.9K | $65.74 | 1.37x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 7.5K | $604.5K | $80.40 | 1.57x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 5.7K | $353.6K | $61.79 | 1.53x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 1.8K | $265.7K | $148.67 | 1.45x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.9K | $221.6K | $76.63 | 1.49x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time per calendar month | 3.4K | $195.9K | $57.04 | 1.45x |
| 99238 | Hospital discharge day management, 30 minutes or less | 2.8K | $192.2K | $67.55 | 1.45x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 645 | $74.2K | $115.09 | 1.56x |
| 99212 | Established patient outpatient visit, total time 10-19 minutes | 1.3K | $68.1K | $52.98 | 1.43x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 261 | $59.1K | $226.44 | 1.42x |
| 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 implem | 1.0K | $49.2K | $49.24 | 1.43x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 1.1K | $43.9K | $38.61 | 1.48x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 437 | $41.7K | $95.41 | 1.53x |
| G0179 | Physician re-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 imp | 1.1K | $40.7K | $38.67 | 1.42x |
| 99315 | Nursing facility discharge day management, 30 minutes or less | 602 | $39.2K | $65.07 | 1.48x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 340 | $39.0K | $114.74 | 1.46x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 247 | $30.0K | $121.29 | 1.47x |
| 93880 | Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck | 149 | $26.3K | $176.31 | 1.56x |
This provider submits charges 1.47 times higher than what Medicare actually pays.
A markup ratio of 1.47x means for every $100 Medicare pays, this provider initially charges $147. 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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