This provider's $4.5M in total Medicare payments ranks in the 99th percentile of Nurse Practitioner providers nationally.
Medicare payments to this provider grew 386% from 2015 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 221% in 2016
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 |
|---|---|---|---|---|---|---|---|
| 2015 | $74.33 | $44.05 | 1.69x | $30.28 | $124.5K | 3.0K | 654 |
| 2016 | $188.42 | $64.92 | 2.90x | $123.50 | $399.4K | 7.9K | 1.9K |
| 2017 | $188.40 | $60.19 | 3.13x | $128.21 | $740.5K | 14.1K | 3.2K |
| 2018 | $195.50 | $64.50 | 3.03x | $131.00 | $669.9K | 12.1K | 4.1K |
| 2019 | $254.03 | $80.74 | 3.15x | $173.29 | $429.0K | 7.5K | 3.1K |
| 2020 | $208.06 | $68.15 | 3.05x | $139.91 | $369.7K | 7.0K | 2.8K |
| 2021 | $243.75 | $75.02 | 3.25x | $168.73 | $491.0K | 8.5K | 2.7K |
| 2022 | $201.15 | $60.54 | 3.32x | $140.61 | $668.7K | 12.0K | 3.7K |
| 2023 | $208.88 | $64.25 | 3.25x | $144.63 | $605.5K | 10.8K | 3.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 11042 | Removal of skin and tissue first 20 sq cm or less | 22.0K | $1.3M | $57.01 | 3.51x |
| 11043 | Removal of skin and/or muscle first 20 sq cm or less | 5.9K | $728.9K | $124.11 | 2.30x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 16.4K | $720.7K | $44.06 | 3.37x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 9.4K | $557.6K | $59.28 | 3.20x |
| 17250 | Application of chemical agent to excessive wound tissue | 14.2K | $391.1K | $27.59 | 5.66x |
| 11044 | Removal of skin and bone first 20 sq cm or less | 1.5K | $280.4K | $183.84 | 2.87x |
| 99304 | Initial nursing facility visit, typically 25 minutes per day | 2.9K | $165.2K | $56.88 | 3.32x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 3.4K | $94.3K | $27.42 | 2.93x |
| 11046 | Removal of skin and/or muscle | 1.9K | $83.9K | $44.46 | 2.84x |
| 11045 | Removal of skin and tissue | 3.3K | $76.1K | $22.81 | 2.64x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 825 | $69.5K | $84.22 | 3.35x |
| 11047 | Removal of skin and bone | 588 | $44.2K | $75.12 | 3.01x |
| 49450 | Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin | 28 | $11.4K | $407.31 | 3.33x |
| 10060 | Drainage of abscess | 145 | $8.8K | $60.76 | 2.39x |
| 43762 | Replacement of stomach stoma tube accessed through skin | 32 | $4.3K | $134.61 | 3.46x |
| G0406 | Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth | 117 | $3.1K | $26.12 | 3.16x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 35 | $2.4K | $67.48 | 6.67x |
| 29581 | Application of vein wound compression system lower leg below knee including ankle and foot | 136 | $1.5K | $11.26 | 4.38x |
| 99406 | Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes | 71 | $880.10 | $12.40 | 2.82x |
| 99231 | Follow-up hospital inpatient care per day, typically 15 minutes | 17 | $438.45 | $25.79 | 3.26x |
This provider submits charges 3.34 times higher than what Medicare actually pays.
A markup ratio of 3.34x means for every $100 Medicare pays, this provider initially charges $334. 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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