This provider's $5.7M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 134% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 70% in 2018
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 | $141.15 | $82.64 | 1.71x | $58.51 | $394.9K | 4.8K | 2.5K |
| 2015 | $161.02 | $92.72 | 1.74x | $68.30 | $436.6K | 5.7K | 3.1K |
| 2016 | $133.61 | $73.81 | 1.81x | $59.80 | $403.7K | 5.5K | 3.1K |
| 2017 | $120.56 | $67.40 | 1.79x | $53.16 | $409.0K | 5.9K | 3.8K |
| 2018 | $154.96 | $59.94 | 2.59x | $95.02 | $695.2K | 11.0K | 7.0K |
| 2019 | $199.30 | $63.52 | 3.14x | $135.78 | $669.1K | 10.0K | 6.3K |
| 2020 | $189.83 | $78.62 | 2.41x | $111.21 | $490.6K | 7.1K | 4.6K |
| 2021 | $115.67 | $69.57 | 1.66x | $46.10 | $547.2K | 8.2K | 5.4K |
| 2022 | $110.44 | $71.37 | 1.55x | $39.07 | $721.1K | 12.3K | 5.7K |
| 2023 | $94.85 | $68.88 | 1.38x | $25.97 | $923.8K | 16.9K | 7.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 21.5K | $1.9M | $89.65 | 1.65x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 9.7K | $575.2K | $59.45 | 1.58x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 9.3K | $446.2K | $47.77 | 1.43x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 2.3K | $374.7K | $164.19 | 1.57x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 4.3K | $370.3K | $85.64 | 1.58x |
| 94729 | Measurement of lung diffusing capacity | 4.3K | $185.6K | $42.81 | 1.90x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 4.3K | $174.5K | $40.28 | 1.92x |
| 94727 | Determination of lung volumes using gas dilution or washout | 4.3K | $145.5K | $33.51 | 2.01x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.2K | $142.2K | $121.39 | 1.77x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 1.2K | $123.0K | $99.89 | 2.60x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 701 | $117.3K | $167.26 | 1.67x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 2.6K | $110.9K | $43.03 | 1.42x |
| 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 | 2.5K | $101.6K | $40.38 | 1.41x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 998 | $95.3K | $95.54 | 2.66x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 657 | $84.2K | $128.11 | 1.71x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 430 | $76.0K | $176.67 | 1.41x |
| 99487 | Complex chronic care management services 60 minutes clinical staff time | 772 | $73.6K | $95.40 | 1.50x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 504 | $63.3K | $125.51 | 1.36x |
| 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 | 1.9K | $63.1K | $33.07 | 1.42x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 260 | $48.5K | $186.63 | 2.03x |
This provider submits charges 1.71 times higher than what Medicare actually pays.
A markup ratio of 1.71x means for every $100 Medicare pays, this provider initially charges $171. 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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