This provider averages 119 services per working day
Based on 59.5K total services over 2 years (250 working days/year). Learn about impossible service volumes →
This provider's $4.3M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
Averaging 119 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 749% from 2022 to 2023.
64% of their billing comes from a single procedure code (99489 — Complex chronic care management services for two or more chronic conditions, each additional 60 minutes of clinical staff time directed by health care professional, per calendar month).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 749% in 2023
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 |
|---|---|---|---|---|---|---|---|
| 2022 | $104.43 | $83.39 | 1.25x | $21.04 | $457.3K | 5.5K | 10 |
| 2023 | $92.14 | $71.81 | 1.28x | $20.33 | $3.9M | 54.0K | 8 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99489 | Complex chronic care management services for two or more chronic conditions, each additional 60 minutes of clinical staff time directed by health care professional, per calendar month | 46.4K | $2.8M | $59.61 | 1.28x |
| 99487 | Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month | 10.1K | $1.1M | $112.20 | 1.30x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 938 | $165.6K | $176.57 | 1.05x |
| 99496 | Transitional care management services for problem of high complexity | 600 | $142.4K | $237.31 | 1.33x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 334 | $46.2K | $138.18 | 1.15x |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 450 | $43.1K | $95.70 | 1.29x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 390 | $20.5K | $52.51 | 1.44x |
| 99495 | Transitional care management services for problem of at least moderate complexity | 116 | $19.2K | $165.09 | 1.28x |
| G0442 | Annual alcohol misuse screening, 15 minutes | 142 | $2.9K | $20.59 | 1.06x |
| G0444 | Annual depression screening, 15 minutes | 91 | $1.8K | $20.20 | 1.19x |
| 99497 | Advance care planning, first 30 minutes | 15 | $1.1K | $71.74 | 1.58x |
This provider submits charges 1.28 times higher than what Medicare actually pays.
A markup ratio of 1.28x means for every $100 Medicare pays, this provider initially charges $128. 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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