This provider's $5.4M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 453% from 2014 to 2023.
62% of their billing comes from a single procedure code (99487 — Complex chronic care management services 60 minutes clinical staff time).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 146% 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 | $134.25 | $69.44 | 1.93x | $64.81 | $183.3K | 4.5K | 894 |
| 2015 | $102.17 | $69.28 | 1.47x | $32.89 | $212.2K | 6.3K | 810 |
| 2016 | $154.95 | $80.68 | 1.92x | $74.27 | $211.4K | 3.1K | 1.4K |
| 2017 | $124.64 | $91.65 | 1.36x | $32.99 | $272.2K | 4.1K | 2.3K |
| 2018 | $127.91 | $83.99 | 1.52x | $43.92 | $259.0K | 4.5K | 2.3K |
| 2019 | $118.31 | $68.89 | 1.72x | $49.42 | $319.6K | 7.0K | 3.5K |
| 2020 | $116.74 | $60.81 | 1.92x | $55.93 | $394.2K | 9.3K | 3.8K |
| 2021 | $119.76 | $54.95 | 2.18x | $64.81 | $970.1K | 15.8K | 5.6K |
| 2022 | $121.81 | $61.01 | 2.00x | $60.80 | $1.5M | 17.2K | 5.8K |
| 2023 | $152.55 | $71.52 | 2.13x | $81.03 | $1.0M | 11.8K | 4.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99487 | Complex chronic care management services 60 minutes clinical staff time | 38.9K | $3.3M | $83.73 | 1.92x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 14.1K | $472.0K | $33.44 | 1.78x |
| 99489 | Complex chronic care management services each additional 30 minutes clinical staff time | 8.6K | $364.5K | $42.45 | 1.94x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 3.4K | $346.7K | $101.57 | 1.68x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 1.2K | $158.6K | $127.33 | 1.43x |
| 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 | 2.7K | $107.3K | $40.37 | 1.74x |
| 99350 | Established patient home visit, typically 60 minutes | 693 | $92.4K | $133.30 | 1.34x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 1.3K | $84.0K | $62.31 | 1.43x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 1.2K | $78.3K | $67.54 | 1.80x |
| 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 2.1K | $41.5K | $20.20 | 1.98x |
| 97112 | Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | 1.5K | $39.6K | $25.69 | 1.56x |
| 99345 | New patient home visit, typically 75 minutes | 250 | $39.2K | $156.73 | 1.40x |
| 99356 | Prolonged inpatient or observation hospital service first hour | 451 | $32.1K | $71.15 | 1.34x |
| 99337 | Established patient assisted living visit, typically 60 minutes | 212 | $31.3K | $147.41 | 1.40x |
| 99354 | Prolonged office or other outpatient service first hour | 345 | $28.6K | $82.84 | 1.30x |
| 97140 | Manual (physical) therapy techniques to 1 or more regions, each 15 minutes | 1.5K | $27.0K | $17.94 | 2.23x |
| 99349 | Established patient home visit, typically 40 minutes | 249 | $23.4K | $93.90 | 1.38x |
| 97032 | Application of electrical stimulation to 1 or more areas, each 15 minutes | 1.9K | $21.5K | $11.23 | 3.56x |
| 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 | 642 | $20.1K | $31.37 | 1.74x |
| 97116 | Walking training to 1 or more areas, each 15 minutes | 1.2K | $19.8K | $16.97 | 2.36x |
This provider submits charges 1.85 times higher than what Medicare actually pays.
A markup ratio of 1.85x means for every $100 Medicare pays, this provider initially charges $185. 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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