This provider's $4.0M in total Medicare payments ranks in the 99th percentile of Nurse Practitioner providers nationally.
Medicare payments to this provider grew 2380% from 2017 to 2023.
63% of their billing comes from a single procedure code (Q4281 — Barrera sl or barrera dl, per square centimeter).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 3134% 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 |
|---|---|---|---|---|---|---|---|
| 2017 | $183.51 | $108.15 | 1.70x | $75.36 | $133.3K | 1.2K | 5 |
| 2018 | $293.59 | $85.86 | 3.42x | $207.73 | $175.8K | 2.0K | 10 |
| 2019 | $300.84 | $85.22 | 3.53x | $215.62 | $138.8K | 1.6K | 10 |
| 2020 | $288.04 | $73.31 | 3.93x | $214.73 | $39.0K | 532 | 7 |
| 2021 | $154.77 | $75.99 | 2.04x | $78.78 | $121.5K | 1.6K | 15 |
| 2022 | $182.84 | $78.05 | 2.34x | $104.79 | $102.3K | 1.3K | 8 |
| 2023 | $1.2K | $910.78 | 1.30x | $275.19 | $3.3M | 3.6K | 11 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| Q4281 | Barrera sl or barrera dl, per square centimeter | 2.1K | $2.5M | $1.2K | 1.28x |
| Q4262 | Dual layer impax membrane, per square centimeter | 948 | $747.9K | $788.96 | 1.30x |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | 3.3K | $284.1K | $85.75 | 3.02x |
| 99350 | Established patient home visit, typically 1 hour | 1.5K | $180.2K | $120.16 | 2.77x |
| G0181 | Physician or allowed practitioner 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 or allow | 1.2K | $90.6K | $77.12 | 2.66x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 377 | $41.2K | $109.23 | 2.15x |
| 99345 | New patient home visit, typically 75 minutes | 261 | $38.1K | $145.98 | 2.82x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 124 | $18.8K | $151.95 | 1.81x |
| 99496 | Transitional care management services for problem of high complexity | 74 | $14.2K | $191.43 | 2.29x |
| 99497 | Advance care planning, first 30 minutes | 157 | $10.2K | $65.10 | 2.03x |
| 99348 | Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes | 181 | $9.1K | $50.24 | 3.34x |
| G0180 | Physician or allowed practitioner 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 and | 245 | $9.0K | $36.55 | 2.27x |
| G0179 | Physician or allowed practitioner 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 a | 303 | $8.7K | $28.87 | 2.22x |
| 15271 | Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less | 80 | $8.0K | $99.90 | 3.40x |
| 99443 | Telephone medical discussion with physician, 21-30 minutes | 91 | $7.4K | $80.99 | 2.58x |
| 99495 | Transitional care management services for problem of moderate complexity | 45 | $6.7K | $148.12 | 2.19x |
| 99406 | Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes | 487 | $6.6K | $13.55 | 2.59x |
| 11042 | Removal of skin and tissue, 20.0 sq cm or less | 43 | $4.0K | $92.02 | 2.41x |
| 99491 | Chronic care management services by qualified health care professional, 30 minutes or more per calendar month | 53 | $3.1K | $59.09 | 3.27x |
| 90682 | Vaccine for influenza for injection into muscle | 37 | $2.0K | $54.89 | 2.73x |
This provider submits charges 1.56 times higher than what Medicare actually pays.
A markup ratio of 1.56x means for every $100 Medicare pays, this provider initially charges $156. 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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