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Practice Management/Leadership

Billing Titans of PM&R: Analyzing the Top 1% of Medicare Earners

Thursday, October 23, 2025
3:45 PM - 5:00 PM MT
Location: Session Room - 250 DEF

    Poster Presenter(s)

  • Matthew Smith, Other

    Medical Student
    Saint Georges University School of Medicine
    Los Altos Hills, California

    • Co-Author(s)

  • JS

    Jacob Freeman Smith, MD

    Resident
    University of Miami - Jackson Health System
    Miami, Florida

  • Timothy Tiu, MD

    Associate Professor
    University of Miami Miller School of Medicine
    Miami, Florida

  • Sony Issac, MD

    Assistant Professor of Clinical
    University of Miami Leonard M Miller School of Medicine Department of PM&R, Florida

Disclosure(s):
Matthew Smith, Other: No financial relationships to disclose
Sony Issac, MD: No financial relationships to disclose
Background and/or Objectives: To characterize the top 1% of Physical Medicine and Rehabilitation (PM&R) physicians by total Medicare earnings in 2022.

Design: Retrospective analysis of publicly available Medicare billing data from 2022.

Setting : National datasets encompassing PM&R physicians billing Medicare.

Participants : PM&R physicians in the top 1% of Medicare earnings in 2022.

Interventions: Not applicable.

Main Outcome Measures: Demographic and practice characteristics, including gender, credentials, urban-rural classification, years of experience, and organization size. Identification of the most reimbursed CPT codes categorized by total Medicare reimbursement. Distribution of Medicare earnings from Evaluation and Management (E&M) versus procedural services. Mann-Whitney U test was used to identify procedural versus E&M billing dominance predictors.

Results: The top 1% of Medicare-earning PM&R physicians in 2022 accounted for 8% of Medicare earnings and 14% of services billed. Most were male (85%), MDs (89%), and practiced in metropolitan areas (95%), with 38% having 21-30 years of experience. The top procedures included hyaluronan injections ($5.9M), botulinum toxin injections ($4.9M), and fluoroscopic-guided needle placement ($3.7M). The most-reimbursed E&M service was a 15-minute nursing facility follow-up ($7.7M). E&M-dominant providers comprised 29 (36%) of top billers, while 51 (64%) were procedural-dominant. Procedural earners had significantly larger organizations (mean: 62 vs. 10 physicians) and billed more total Medicare services (57,542 vs. 13,062) (p < 0.05). Years in practice and urban-rural designation showed no significant differences.

Conclusions: The top 1% of Medicare-earning PM&R physicians contribute disproportionately to Medicare expenditures and volume. Proceduralists generated higher service counts and operated within larger organizations. These findings highlight the concentration of Medicare reimbursement within a small subset of PM&R physicians and suggest that practice structure and service type play key roles in billing patterns. Future research should explore additional factors to better understand drivers of high Medicare earnings in PM&R.