This provider's $5.0M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
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 | $132.18 | $53.86 | 2.45x | $78.32 | $499.7K | 9.7K | 5.2K |
| 2015 | $122.61 | $51.72 | 2.37x | $70.89 | $453.0K | 8.8K | 5.0K |
| 2016 | $127.70 | $52.62 | 2.43x | $75.08 | $502.0K | 9.7K | 5.0K |
| 2017 | $118.67 | $50.29 | 2.36x | $68.38 | $507.8K | 9.8K | 5.2K |
| 2018 | $125.10 | $53.68 | 2.33x | $71.42 | $466.8K | 8.5K | 4.4K |
| 2019 | $120.67 | $52.56 | 2.30x | $68.11 | $519.2K | 9.5K | 5.1K |
| 2020 | $109.50 | $53.00 | 2.07x | $56.50 | $594.9K | 10.4K | 4.7K |
| 2021 | $98.99 | $48.68 | 2.03x | $50.31 | $572.1K | 9.1K | 3.5K |
| 2022 | $131.88 | $66.86 | 1.97x | $65.02 | $466.6K | 7.2K | 3.2K |
| 2023 | $135.89 | $68.48 | 1.98x | $67.41 | $453.7K | 6.5K | 2.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 26.8K | $2.1M | $78.84 | 2.17x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 8.7K | $451.2K | $51.69 | 2.21x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 1.8K | $330.2K | $185.37 | 1.47x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 2.9K | $233.8K | $80.20 | 2.29x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.5K | $156.8K | $106.46 | 2.19x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 4.2K | $137.7K | $32.81 | 1.80x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 901 | $136.4K | $151.37 | 2.28x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 1.0K | $117.1K | $114.32 | 1.44x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 2.1K | $114.8K | $54.60 | 2.34x |
| 99239 | Hospital discharge day management, more than 30 minutes | 1.2K | $98.1K | $81.22 | 2.27x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 2.1K | $84.5K | $40.77 | 1.60x |
| 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 im | 2.8K | $83.2K | $29.37 | 4.26x |
| 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 | 2.2K | $83.0K | $37.01 | 1.49x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 1.5K | $68.2K | $46.11 | 4.34x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 980 | $65.8K | $67.10 | 1.56x |
| 93000 | Routine EKG using at least 12 leads including interpretation and report | 5.7K | $62.6K | $11.05 | 3.62x |
| 99458 | Remote physiologic monitoring treatment management services, health care professional time in a calendar month requiring interactive communication with the patient/caregiver; each additional 20 minute | 2.0K | $61.0K | $30.83 | 1.46x |
| 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 | 736 | $58.7K | $79.69 | 2.87x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 527 | $53.0K | $100.55 | 2.34x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 2.1K | $48.5K | $23.31 | 2.27x |
This provider submits charges 2.19 times higher than what Medicare actually pays.
A markup ratio of 2.19x means for every $100 Medicare pays, this provider initially charges $219. 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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