This provider's $7.7M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 117% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 64% in 2015
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 | $791.10 | $150.82 | 5.25x | $640.28 | $446.8K | 3.7K | 2.0K |
| 2015 | $810.35 | $151.75 | 5.34x | $658.60 | $731.4K | 6.3K | 3.0K |
| 2016 | $810.00 | $152.33 | 5.32x | $657.67 | $879.1K | 7.6K | 3.0K |
| 2017 | $666.48 | $125.50 | 5.31x | $540.98 | $876.5K | 7.6K | 3.1K |
| 2018 | $743.99 | $130.75 | 5.69x | $613.24 | $767.6K | 7.0K | 3.4K |
| 2019 | $720.16 | $120.45 | 5.98x | $599.71 | $773.7K | 7.4K | 3.7K |
| 2020 | $1.0K | $147.65 | 7.11x | $901.48 | $720.6K | 7.8K | 3.6K |
| 2021 | $949.28 | $144.82 | 6.55x | $804.46 | $704.4K | 6.8K | 3.7K |
| 2022 | $867.89 | $129.85 | 6.68x | $738.04 | $839.3K | 8.5K | 4.4K |
| 2023 | $871.56 | $126.96 | 6.86x | $744.60 | $970.3K | 9.4K | 4.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 22.3K | $2.0M | $88.91 | 2.80x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 8.1K | $1.5M | $184.88 | 3.25x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 5.8K | $976.9K | $168.61 | 2.68x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 9.2K | $898.5K | $98.08 | 2.45x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 3.6K | $489.1K | $134.55 | 3.03x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 631 | $358.3K | $567.82 | 8.71x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 560 | $334.9K | $598.06 | 9.11x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 1.4K | $243.6K | $175.40 | 2.30x |
| 99292 | Critical care delivery critically ill or injured patient | 2.2K | $206.0K | $93.54 | 2.69x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 3.2K | $137.4K | $43.06 | 7.87x |
| 94729 | Measurement of lung diffusing capacity | 1.9K | $91.9K | $49.46 | 6.29x |
| 94726 | Determination of lung volumes using plethysmography | 1.2K | $61.2K | $49.61 | 7.05x |
| 99238 | Hospital discharge day management, 30 minutes or less | 946 | $58.3K | $61.63 | 2.79x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 891 | $54.6K | $61.23 | 3.11x |
| 94664 | Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | 3.2K | $50.9K | $15.73 | 3.19x |
| 94660 | Initiation and management of continued pressured respiratory assistance by mask or breathing tube | 764 | $40.9K | $53.58 | 2.50x |
| 94640 | Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen | 3.0K | $40.1K | $13.31 | 13.92x |
| 93306 | Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function | 179 | $32.0K | $178.83 | 3.41x |
| 94618 | Test for exercise-induced lung stress | 1.0K | $30.5K | $29.09 | 6.87x |
| G0399 | Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation | 171 | $29.8K | $174.05 | 2.30x |
This provider submits charges 3.67 times higher than what Medicare actually pays.
A markup ratio of 3.67x means for every $100 Medicare pays, this provider initially charges $367. 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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