This provider's $4.6M in total Medicare payments ranks in the 99th percentile of Geriatric 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 | $109.33 | $82.80 | 1.32x | $26.53 | $528.5K | 6.5K | 1.3K |
| 2015 | $111.26 | $81.35 | 1.37x | $29.91 | $499.7K | 6.2K | 1.2K |
| 2016 | $106.72 | $75.93 | 1.41x | $30.79 | $439.9K | 5.8K | 1.2K |
| 2017 | $128.17 | $90.81 | 1.41x | $37.36 | $439.2K | 5.7K | 1.3K |
| 2018 | $124.35 | $90.52 | 1.37x | $33.83 | $476.7K | 5.9K | 1.6K |
| 2019 | $118.44 | $89.35 | 1.33x | $29.09 | $430.9K | 5.1K | 1.3K |
| 2020 | $116.63 | $99.23 | 1.18x | $17.40 | $500.5K | 4.9K | 976 |
| 2021 | $112.23 | $94.30 | 1.19x | $17.93 | $434.5K | 4.4K | 831 |
| 2022 | $115.04 | $85.42 | 1.35x | $29.62 | $403.6K | 4.8K | 871 |
| 2023 | $122.03 | $94.04 | 1.30x | $27.99 | $460.2K | 5.2K | 1.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 33.8K | $2.7M | $78.80 | 1.29x |
| 99336 | Established patient assisted living visit, typically 40 minutes | 8.1K | $902.7K | $111.08 | 1.33x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 2.1K | $299.7K | $144.79 | 1.27x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.2K | $266.7K | $82.98 | 1.53x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 738 | $97.0K | $131.44 | 1.03x |
| 99316 | Nursing facility discharge management, more than 30 minutes | 970 | $89.6K | $92.38 | 1.29x |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | 703 | $69.8K | $99.25 | 1.37x |
| 99327 | New patient assisted living visit, typically 60 minutes | 270 | $39.8K | $147.33 | 1.38x |
| 99211 | Established patient office or other outpatient visit, typically 5 minutes | 2.0K | $31.6K | $15.56 | 1.62x |
| 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 | 532 | $24.2K | $45.53 | 1.33x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 199 | $24.0K | $120.50 | 1.44x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 162 | $17.7K | $109.54 | 1.37x |
| 99354 | Prolonged office or other outpatient service first hour | 182 | $17.5K | $96.25 | 1.32x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 99 | $14.8K | $149.03 | 1.49x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 122 | $10.5K | $86.07 | 1.32x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 118 | $8.0K | $68.03 | 1.26x |
| 99337 | Established patient assisted living visit, typically 60 minutes | 51 | $8.0K | $157.38 | 1.35x |
| 96116 | Neurobehavioral status examination, interpretation, and report by psychologist or physician per hour | 89 | $6.9K | $77.99 | 1.32x |
| 93000 | Routine EKG using at least 12 leads including interpretation and report | 454 | $5.8K | $12.87 | 1.51x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 124 | $3.7K | $29.97 | 1.45x |
This provider submits charges 1.31 times higher than what Medicare actually pays.
A markup ratio of 1.31x means for every $100 Medicare pays, this provider initially charges $131. 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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