This provider's $7.6M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
61% of their billing comes from a single procedure code (99308 — Subsequent nursing facility visit, typically 15 minutes per day).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 59% 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 | $158.69 | $82.19 | 1.93x | $76.50 | $1.1M | 17.0K | 2.8K |
| 2015 | $106.52 | $69.56 | 1.53x | $36.96 | $892.2K | 13.5K | 2.7K |
| 2016 | $96.53 | $62.70 | 1.54x | $33.83 | $581.3K | 8.6K | 2.3K |
| 2017 | $128.12 | $67.34 | 1.90x | $60.78 | $434.5K | 6.8K | 1.5K |
| 2018 | $144.17 | $59.58 | 2.42x | $84.59 | $471.7K | 7.3K | 1.3K |
| 2019 | $153.23 | $66.82 | 2.29x | $86.41 | $487.6K | 7.2K | 1.3K |
| 2020 | $141.30 | $68.74 | 2.06x | $72.56 | $499.6K | 7.2K | 1.2K |
| 2021 | $155.73 | $82.57 | 1.89x | $73.16 | $794.1K | 11.0K | 1.5K |
| 2022 | $154.71 | $78.07 | 1.98x | $76.64 | $954.7K | 13.2K | 1.8K |
| 2023 | $142.68 | $79.68 | 1.79x | $63.00 | $1.3M | 17.2K | 2.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 71.7K | $4.5M | $63.03 | 2.03x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 6.1K | $500.8K | $81.63 | 2.04x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 2.9K | $435.5K | $150.53 | 1.65x |
| 99335 | Established patient assisted living visit, typically 25 minutes | 4.3K | $376.4K | $88.06 | 2.27x |
| 99349 | Established patient home visit, typically 40 minutes | 2.8K | $320.9K | $115.89 | 1.29x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.5K | $230.7K | $91.29 | 1.56x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.1K | $217.0K | $69.74 | 1.49x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 3.1K | $205.0K | $66.19 | 2.10x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 3.7K | $144.4K | $38.56 | 1.94x |
| 99316 | Nursing facility discharge management, more than 30 minutes | 1.1K | $107.6K | $95.39 | 1.95x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 303 | $59.5K | $196.31 | 1.70x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 378 | $47.9K | $126.83 | 1.68x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 930 | $47.4K | $51.01 | 1.57x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 292 | $36.2K | $124.10 | 1.69x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 177 | $31.4K | $177.39 | 1.62x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 256 | $30.3K | $118.31 | 1.90x |
| 99239 | Hospital discharge day management, more than 30 minutes | 259 | $24.8K | $95.80 | 1.30x |
| 99348 | Established patient home visit, typically 25 minutes | 352 | $24.7K | $70.31 | 1.68x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 329 | $23.9K | $72.51 | 1.43x |
| 99238 | Hospital discharge day management, 30 minutes or less | 353 | $23.7K | $67.05 | 2.70x |
This provider submits charges 1.96 times higher than what Medicare actually pays.
A markup ratio of 1.96x means for every $100 Medicare pays, this provider initially charges $196. 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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