This provider's $3.4M in total Medicare payments ranks in the 98th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 10368% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 1733% 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 |
|---|---|---|---|---|---|---|---|
| 2014 | $170.50 | $78.33 | 2.18x | $92.17 | $2.8K | 36 | 33 |
| 2015 | $192.77 | $75.91 | 2.54x | $116.86 | $28.7K | 425 | 340 |
| 2016 | $297.33 | $102.25 | 2.91x | $195.08 | $32.0K | 240 | 148 |
| 2017 | $264.79 | $122.72 | 2.16x | $142.07 | $587.2K | 6.5K | 2.2K |
| 2018 | $235.99 | $123.97 | 1.90x | $112.02 | $730.0K | 8.5K | 2.7K |
| 2019 | $272.86 | $127.26 | 2.14x | $145.60 | $688.7K | 7.0K | 2.5K |
| 2020 | $148.23 | $74.94 | 1.98x | $73.29 | $431.1K | 4.0K | 1.5K |
| 2021 | $154.17 | $82.90 | 1.86x | $71.27 | $275.2K | 1.9K | 826 |
| 2022 | $183.33 | $79.79 | 2.30x | $103.54 | $300.3K | 2.5K | 1.1K |
| 2023 | $235.45 | $96.58 | 2.44x | $138.87 | $295.2K | 2.5K | 964 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 8.7K | $1.5M | $172.32 | 2.01x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 12.7K | $715.5K | $56.35 | 2.24x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 2.9K | $444.4K | $154.86 | 1.79x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 4.4K | $363.0K | $82.20 | 2.25x |
| 99292 | Critical care delivery critically ill or injured patient | 994 | $81.2K | $81.69 | 2.71x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 917 | $50.7K | $55.28 | 1.98x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 534 | $46.4K | $86.87 | 1.98x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 84 | $38.7K | $460.18 | 2.00x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 73 | $32.7K | $447.72 | 1.98x |
| 94618 | Test for exercise-induced lung stress | 587 | $15.0K | $25.50 | 1.97x |
| 94729 | Measurement of lung diffusing capacity | 232 | $9.7K | $41.78 | 1.90x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 294 | $8.9K | $30.17 | 2.51x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 196 | $8.4K | $43.02 | 2.38x |
| 94727 | Determination of lung volumes using gas dilution or washout | 219 | $7.2K | $32.83 | 1.92x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 59 | $6.1K | $103.89 | 2.17x |
| 99238 | Hospital discharge day management, 30 minutes or less | 105 | $5.8K | $55.30 | 2.55x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 43 | $5.5K | $127.44 | 2.31x |
| 94620 | Pulmonary exercise testing | 127 | $5.4K | $42.19 | 1.94x |
| 99219 | Hospital observation care typically 50 minutes | 53 | $5.2K | $98.87 | 2.09x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 57 | $4.6K | $81.04 | 2.06x |
This provider submits charges 2.08 times higher than what Medicare actually pays.
A markup ratio of 2.08x means for every $100 Medicare pays, this provider initially charges $208. This is higher 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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