This provider's $7.6M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 74% from 2014 to 2023.
60% 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.
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 | $150.78 | $84.06 | 1.79x | $66.72 | $562.8K | 6.9K | 2.3K |
| 2015 | $179.53 | $100.21 | 1.79x | $79.32 | $687.1K | 8.5K | 2.9K |
| 2016 | $210.45 | $110.05 | 1.91x | $100.40 | $755.6K | 9.7K | 3.0K |
| 2017 | $278.60 | $95.51 | 2.92x | $183.09 | $685.8K | 9.5K | 3.0K |
| 2018 | $310.08 | $92.41 | 3.36x | $217.67 | $741.7K | 10.1K | 3.5K |
| 2019 | $313.96 | $89.72 | 3.50x | $224.24 | $715.3K | 10.7K | 3.0K |
| 2020 | $290.00 | $91.08 | 3.18x | $198.92 | $770.0K | 11.7K | 2.9K |
| 2021 | $282.47 | $85.83 | 3.29x | $196.64 | $804.5K | 11.6K | 2.9K |
| 2022 | $334.13 | $92.80 | 3.60x | $241.33 | $928.7K | 13.6K | 3.3K |
| 2023 | $335.00 | $93.19 | 3.59x | $241.81 | $981.6K | 13.7K | 3.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 74.6K | $4.6M | $61.63 | 4.29x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 16.5K | $1.3M | $79.31 | 2.95x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 9.0K | $1.0M | $114.11 | 2.81x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 2.4K | $345.2K | $143.36 | 2.58x |
| 99349 | Established patient home visit, typically 40 minutes | 1.9K | $198.3K | $106.73 | 1.87x |
| 99345 | New patient home visit, typically 75 minutes | 267 | $49.8K | $186.38 | 1.54x |
| 99350 | Established patient home visit, typically 60 minutes | 159 | $24.1K | $151.31 | 1.97x |
| 11042 | Removal of skin and tissue first 20 sq cm or less | 308 | $22.9K | $74.37 | 2.84x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 526 | $20.6K | $39.23 | 5.10x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 89 | $18.4K | $206.31 | 1.46x |
| G0179 | Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial im | 134 | $4.9K | $36.62 | 1.81x |
| 69210 | Removal of impact ear wax, one ear | 106 | $4.8K | $44.90 | 1.68x |
| 99304 | Initial nursing facility visit, typically 25 minutes per day | 50 | $4.0K | $79.42 | 1.59x |
| G0008 | Administration of influenza virus vaccine | 86 | $2.1K | $24.07 | 1.59x |
| 11043 | Removal of skin and/or muscle first 20 sq cm or less | 13 | $1.9K | $149.51 | 2.34x |
| Q2037 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) | 86 | $1.3K | $15.34 | 3.27x |
This provider submits charges 3.68 times higher than what Medicare actually pays.
A markup ratio of 3.68x means for every $100 Medicare pays, this provider initially charges $368. 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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