Statistical flag only — not an accusation of fraud
This provider's $10.1M in total Medicare payments ranks in the 99th percentile of Plastic and Reconstructive Surgery providers nationally.
Medicare payments to this provider grew 20915% from 2016 to 2023.
This provider has been statistically flagged with a risk score of 66/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 1382% in 2017
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 |
|---|---|---|---|---|---|---|---|
| 2016 | $203.49 | $86.37 | 2.36x | $117.12 | $18.4K | 213 | 4 |
| 2017 | $269.17 | $81.74 | 3.29x | $187.43 | $272.6K | 3.3K | 16 |
| 2018 | $302.53 | $81.15 | 3.73x | $221.38 | $580.2K | 7.2K | 12 |
| 2019 | $301.25 | $85.42 | 3.53x | $215.83 | $863.5K | 10.1K | 11 |
| 2020 | $294.02 | $91.56 | 3.21x | $202.46 | $1.1M | 11.8K | 11 |
| 2021 | $333.93 | $98.39 | 3.39x | $235.54 | $1.3M | 12.9K | 11 |
| 2022 | $424.39 | $154.71 | 2.74x | $269.68 | $2.2M | 14.1K | 15 |
| 2023 | $573.23 | $289.01 | 1.98x | $284.22 | $3.9M | 13.4K | 15 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| Q4217 | Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter | 4.0K | $3.6M | $908.26 | 1.39x |
| 97597 | Removal of tissue from wound, 20.0 sq cm or less | 19.7K | $1.8M | $90.14 | 2.92x |
| 11043 | Removal of muscle and/or tissue, 20.0 sq cm or less | 6.1K | $1.4M | $221.97 | 3.55x |
| 99348 | Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes | 13.9K | $1.0M | $75.28 | 3.80x |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | 7.5K | $866.0K | $114.81 | 3.78x |
| 97598 | Removal of tissue from wound, each additional 20.0 sq cm | 10.5K | $420.1K | $40.15 | 2.16x |
| Q4196 | Puraply am, per square centimeter | 2.7K | $230.0K | $86.26 | 6.53x |
| 99343 | New patient home visit, typically 45 minutes | 1.4K | $152.4K | $106.49 | 4.02x |
| 11046 | Removal of muscle and/or tissue, each additional 20.0 sq cm or less | 1.9K | $137.1K | $70.73 | 3.51x |
| 29581 | Application of vein wound compression bandages on lower leg, ankle, and foot | 1.6K | $120.9K | $77.78 | 2.84x |
| 11044 | Removal of bone, 20.0 sq cm or less | 323 | $97.9K | $303.06 | 3.64x |
| 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 | 549 | $81.4K | $148.33 | 3.37x |
| 99344 | Residence visit for new patient with moderate level of medical decision making, per day, if using time, at least 60 minutes | 409 | $48.4K | $118.39 | 5.21x |
| 97605 | Therapy procedure using a special bandage and vacuum pump, surface area 50.0 sq cm or less | 840 | $33.5K | $39.89 | 3.56x |
| 99342 | New patient home visit, typically 30 minutes | 468 | $31.5K | $67.32 | 4.03x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 472 | $28.0K | $59.31 | 2.87x |
| 15002 | Preparation of skin graft site of trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less | 67 | $22.7K | $338.80 | 3.65x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 139 | $10.7K | $77.24 | 2.46x |
| 11047 | Removal of bone, each additional 20.0 sq cm or less | 71 | $8.5K | $119.83 | 3.70x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 69 | $8.0K | $115.78 | 2.44x |
This provider submits charges 2.72 times higher than what Medicare actually pays.
A markup ratio of 2.72x means for every $100 Medicare pays, this provider initially charges $272. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
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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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