Opal Medical Group, P.A.

Opal Medical Group, P.A. was paid $1.94M by Medicaid between Jan 2018 and Dec 2024, across 20 billing codes. Its largest line is 99309, Subsequent nursing facility care, per day, low to moderate complexity — 53% of everything it billed.

33Billing provider infoOPAL MEDICAL GROUP, P.A.
HAGERSTOWN, MD 21740

33aNPI1477639862assigned 10/27/2006

33bProvider typeInternal Medicine Physician

28Total paid$1.94M

24GClaims46,212

24DCodes billed20

24AFirst – last monthJan 2018 – Dec 2024

Compared with peers

Next to other Internal Medicine Physician providers in Maryland

Rank by total paid#22 of 501

Median peer was paid$77K

This provider vs. median25×

Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	11,512	$648K
2019	8,402	$328K
2020	7,809	$276K
2021	6,319	$218K
2022	4,387	$152K
2023	3,982	$159K
2024incomplete	3,801	$155K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99309	Subsequent nursing facility care, per day, low to moderate complexity	53%	28,647	13,051	$1.03M
99214	Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	22%	5,130	4,218	$433K
99308	Subsequent nursing facility care, per day, straightforward	16%	8,988	5,504	$309K
99310	Prolong nursin fac eval 15m	5.5%	2,008	1,301	$106K
99306	Prolong nursin fac eval 15m	1.1%	190	156	$21K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	<1%	239	205	$12K
99307		<1%	245	180	$8K
99215	Doctor's office visit, returning patient (complex)Prolong outpt/office vis	<1%	35	33	$5K
G2211	Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)	<1%	292	237	$4K
99232	Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity	<1%	60	14	$4K
99318		<1%	31	29	$3K
99305		<1%	15	14	$2K

8 more codes

99497		<1%	122	$866.53
90682		<1%	15	$747.32
99356		<1%	16	$667.91
90688		<1%	37	$387.42
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	<1%	15	$209.16
G0008	Administration of influenza virus vaccine	<1%	83	$17.14
G0444	Annual depression screening, 5 to 15 minutes	0%	14	$0.00
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	0%	30	$-1007.80

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.

From NPPES

Who's on the registration

Authorized officialHOSE, AMY (OFFICE MANAGER)