This provider's $3.6M in total Medicare payments ranks in the 99th percentile of Sleep Medicine providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 88% in 2020
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 | $454.65 | $110.85 | 4.10x | $343.80 | $287.0K | 2.3K | 1.8K |
| 2015 | $408.50 | $103.38 | 3.95x | $305.12 | $338.7K | 2.4K | 2.1K |
| 2016 | $416.21 | $98.61 | 4.22x | $317.60 | $399.1K | 3.0K | 2.6K |
| 2017 | $564.39 | $107.80 | 5.24x | $456.59 | $457.9K | 3.6K | 3.1K |
| 2018 | $585.77 | $110.86 | 5.28x | $474.91 | $436.9K | 3.5K | 2.9K |
| 2019 | $418.69 | $98.30 | 4.26x | $320.39 | $272.5K | 1.9K | 1.6K |
| 2020 | $373.67 | $93.88 | 3.98x | $279.79 | $512.6K | 8.7K | 3.8K |
| 2021 | $439.17 | $105.12 | 4.18x | $334.05 | $292.4K | 2.5K | 1.8K |
| 2022 | $493.20 | $115.14 | 4.28x | $378.06 | $252.9K | 1.8K | 1.3K |
| 2023 | $441.50 | $102.20 | 4.32x | $339.30 | $355.7K | 4.0K | 2.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 1.9K | $944.6K | $498.97 | 4.74x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 1.6K | $745.1K | $473.70 | 4.64x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 6.4K | $515.4K | $80.89 | 3.99x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 2.3K | $235.4K | $102.16 | 4.99x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 4.0K | $190.8K | $48.02 | 2.56x |
| 99457 | Remote monitoring of physiologic parameters management services, 20 minutes or more of qualified health care professional time per calendar month | 3.9K | $157.2K | $39.80 | 2.47x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.2K | $136.7K | $117.67 | 4.21x |
| 95800 | Study of sleep patterns | 856 | $103.9K | $121.43 | 4.87x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.7K | $91.6K | $53.43 | 4.09x |
| 95806 | Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort | 731 | $70.3K | $96.20 | 5.87x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 1.5K | $65.7K | $42.66 | 2.62x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 340 | $58.8K | $172.93 | 4.65x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 1.6K | $53.1K | $33.43 | 4.37x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 401 | $31.9K | $79.55 | 4.02x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 195 | $29.5K | $151.50 | 4.20x |
| 99458 | Remote physiologic monitoring treatment management services, health care professional time in a calendar month requiring interactive communication with the patient/caregiver; each additional 20 minute | 713 | $23.1K | $32.44 | 2.30x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 313 | $17.2K | $54.80 | 4.13x |
| 99439 | Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month | 357 | $13.1K | $36.78 | 2.04x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 467 | $12.4K | $26.47 | 4.46x |
| 99453 | Remote monitoring of physiologic parameters, initial set-up and patient education on use of equipment | 827 | $12.0K | $14.50 | 2.09x |
This provider submits charges 4.3 times higher than what Medicare actually pays.
A markup ratio of 4.3x means for every $100 Medicare pays, this provider initially charges $430. 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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