This provider's $4.5M in total Medicare payments ranks in the 99th percentile of Geriatric Medicine providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
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 | $158.51 | $84.82 | 1.87x | $73.69 | $472.6K | 5.8K | 1.7K |
| 2015 | $157.15 | $88.64 | 1.77x | $68.51 | $489.9K | 6.0K | 2.0K |
| 2016 | $168.37 | $94.42 | 1.78x | $73.95 | $476.3K | 5.8K | 1.9K |
| 2017 | $167.40 | $93.34 | 1.79x | $74.06 | $501.4K | 6.0K | 1.9K |
| 2018 | $158.20 | $88.41 | 1.79x | $69.79 | $487.3K | 5.9K | 1.7K |
| 2019 | $268.55 | $95.75 | 2.80x | $172.80 | $392.3K | 4.7K | 1.4K |
| 2020 | $370.46 | $97.36 | 3.81x | $273.10 | $438.2K | 4.7K | 1.4K |
| 2021 | $365.41 | $98.25 | 3.72x | $267.16 | $389.1K | 4.1K | 1.3K |
| 2022 | $242.52 | $98.56 | 2.46x | $143.96 | $385.5K | 4.1K | 1.3K |
| 2023 | $216.18 | $108.75 | 1.99x | $107.43 | $448.8K | 4.4K | 1.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 14.5K | $1.2M | $79.56 | 2.49x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 10.1K | $905.9K | $90.04 | 2.41x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 2.3K | $384.1K | $168.17 | 2.38x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.9K | $330.4K | $85.32 | 2.39x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 5.4K | $295.6K | $55.11 | 2.55x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 2.0K | $280.0K | $143.13 | 2.25x |
| 99350 | Established patient home visit, typically 60 minutes | 1.6K | $216.8K | $135.19 | 2.26x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 3.5K | $214.8K | $60.98 | 2.12x |
| 99239 | Hospital discharge day management, more than 30 minutes | 2.0K | $185.7K | $92.25 | 2.25x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 790 | $96.5K | $122.21 | 2.56x |
| 99316 | Nursing facility discharge management, more than 30 minutes | 691 | $62.9K | $91.08 | 2.10x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 361 | $48.1K | $133.31 | 2.53x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 818 | $47.1K | $57.57 | 2.00x |
| 99220 | Hospital observation care typically 70 minutes per day | 238 | $36.2K | $152.04 | 2.16x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 197 | $32.8K | $166.40 | 2.35x |
| 99354 | Prolonged office or other outpatient service first hour | 234 | $23.6K | $100.69 | 2.29x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 158 | $17.8K | $112.42 | 1.81x |
| G0180 | Physician 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 imple | 391 | $17.5K | $44.85 | 2.46x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 135 | $17.4K | $128.91 | 1.95x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 465 | $16.6K | $35.67 | 1.68x |
This provider submits charges 2.38 times higher than what Medicare actually pays.
A markup ratio of 2.38x means for every $100 Medicare pays, this provider initially charges $238. 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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