This provider's $3.6M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 223% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 189% in 2019
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 | $225.96 | $64.88 | 3.48x | $161.08 | $63.7K | 821 | 319 |
| 2015 | $293.31 | $76.79 | 3.82x | $216.52 | $78.5K | 969 | 207 |
| 2016 | $192.68 | $90.93 | 2.12x | $101.75 | $107.3K | 1.3K | 431 |
| 2017 | $138.80 | $71.02 | 1.95x | $67.78 | $127.8K | 1.6K | 791 |
| 2018 | $142.40 | $83.29 | 1.71x | $59.11 | $208.4K | 2.6K | 1.4K |
| 2019 | $172.50 | $68.68 | 2.51x | $103.82 | $602.3K | 16.5K | 2.6K |
| 2020 | $158.54 | $60.67 | 2.61x | $97.87 | $971.5K | 28.8K | 3.9K |
| 2021 | $115.77 | $46.53 | 2.49x | $69.24 | $537.9K | 17.5K | 1.7K |
| 2022 | $137.54 | $56.11 | 2.45x | $81.43 | $730.0K | 24.0K | 2.5K |
| 2023 | $160.79 | $66.52 | 2.42x | $94.27 | $206.0K | 8.1K | 1.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99483 | Assessment of and care planning for patient with impaired thought processing, typically 50 minutes | 2.4K | $511.6K | $217.24 | 2.53x |
| 90839 | Psychotherapy for crisis, first 60 minutes | 3.6K | $425.1K | $117.00 | 2.57x |
| 97535 | Self-care or home management training, each 15 minutes | 15.9K | $358.5K | $22.52 | 3.44x |
| 99211 | Established patient office or other outpatient visit, typically 5 minutes | 17.1K | $315.9K | $18.51 | 2.81x |
| 97530 | Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes | 10.9K | $298.8K | $27.40 | 3.22x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.3K | $198.1K | $85.79 | 2.36x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.8K | $150.2K | $83.07 | 2.29x |
| 99349 | Established patient home visit, typically 40 minutes | 1.3K | $125.0K | $95.00 | 1.88x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 918 | $121.0K | $131.79 | 1.65x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 1.0K | $112.8K | $110.53 | 3.35x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 1.3K | $91.7K | $69.87 | 2.20x |
| 90840 | Psychotherapy for crisis | 1.5K | $85.5K | $57.67 | 2.43x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 1.4K | $79.0K | $55.43 | 2.49x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 391 | $63.3K | $162.01 | 1.85x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.1K | $62.2K | $58.66 | 2.43x |
| 99484 | Care management services for behavioral health conditions, at least 20 minutes clinical staff time | 1.6K | $60.1K | $37.71 | 2.77x |
| 97533 | Sensory technique to enhance processing and adaptation to environmental demands, each 15 minutes | 1.3K | $47.1K | $36.87 | 3.08x |
| 96160 | Administration and interpretation of patient-focused health risk assessment | 18.5K | $38.9K | $2.10 | 4.77x |
| 97537 | Community or work reintegration training, each 15 minutes | 1.8K | $38.7K | $21.79 | 3.42x |
| 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 1.6K | $32.9K | $21.16 | 3.88x |
This provider submits charges 2.69 times higher than what Medicare actually pays.
A markup ratio of 2.69x means for every $100 Medicare pays, this provider initially charges $269. 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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