REX L MAHNENSMITH, M.D.
NPI 1760466528, individual, Waterbury, CT, Internal Medicine
- Hours beyond a day in 20 months, but with up to 2731 patients a month across 3 billing organizations, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code 95165 ($1117 per patient-month) sit in the top 5% of every provider billing that code.
Hours billed per day
Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.
| month | what was found | hours per day, lower bound | hours per day, at price | hours per day, conservative | per working day | patients | billing organizations | codes | paid |
|---|---|---|---|---|---|---|---|---|---|
| Nov 2018 | More hours than a day holds, even counting one unit per claim line | 29.4 | 52.1 | 34.7 | 47.4 | 1568 | 3 | 99203 99204 99213 99214 | $186K |
| Dec 2018 | More hours than a day holds, even counting one unit per claim line | 26.4 | 47.3 | 31.5 | 46.6 | 1451 | 3 | 99203 99204 99213 99214 | $174K |
| Jan 2019 | More hours than a day holds, even counting one unit per claim line | 32.9 | 58.5 | 39.0 | 52.6 | 1773 | 3 | 99203 99204 99213 99214 | $213K |
| Feb 2019 | More hours than a day holds, even counting one unit per claim line | 34.2 | 60.3 | 40.2 | 56.3 | 1719 | 3 | 99203 99204 99213 99214 | $199K |
| Mar 2019 | More hours than a day holds, even counting one unit per claim line | 32.0 | 57.1 | 38.0 | 56.2 | 1825 | 3 | 99203 99204 99213 99214 | $206K |
| Apr 2019 | More hours than a day holds, even counting one unit per claim line | 30.1 | 54.1 | 36.1 | 49.2 | 1711 | 3 | 99203 99204 99213 99214 | $188K |
| May 2019 | More hours than a day holds, even counting one unit per claim line | 33.9 | 60.6 | 40.4 | 54.5 | 1965 | 2 | 99203 99204 99213 99214 | $221K |
| Jun 2019 | More hours than a day holds, even counting one unit per claim line | 29.4 | 52.6 | 35.1 | 52.6 | 1630 | 2 | 99203 99204 99213 99214 | $184K |
| Jul 2019 | More hours than a day holds, even counting one unit per claim line | 29.0 | 52.4 | 35.0 | 47.1 | 1668 | 2 | 99203 99204 99213 99214 | $190K |
| Aug 2019 | More hours than a day holds, even counting one unit per claim line | 26.7 | 47.7 | 31.8 | 44.8 | 1462 | 2 | 99203 99204 99213 99214 | $174K |
| Sep 2019 | More hours than a day holds, even counting one unit per claim line | 35.9 | 64.4 | 42.9 | 61.3 | 1919 | 2 | 99203 99204 99213 99214 | $228K |
| Oct 2019 | More hours than a day holds, even counting one unit per claim line | 37.8 | 68.6 | 45.7 | 61.6 | 2103 | 2 | 99203 99204 99213 99214 | $249K |
| Nov 2019 | More hours than a day holds, even counting one unit per claim line | 35.1 | 62.1 | 41.4 | 59.1 | 1878 | 2 | 99203 99204 99213 99214 | $219K |
| Dec 2019 | More hours than a day holds, even counting one unit per claim line | 31.6 | 56.3 | 37.5 | 52.9 | 1724 | 2 | 99203 99204 99213 99214 | $207K |
| Jan 2020 | More hours than a day holds, even counting one unit per claim line | 50.5 | 86.7 | 57.8 | 77.9 | 2684 | 1 | 99203 99204 99213 99214 | $335K |
| Feb 2020 | More hours than a day holds, even counting one unit per claim line | 56.7 | 99.4 | 66.3 | 96.1 | 2731 | 1 | 99203 99204 99213 99214 | $359K |
| Mar 2020 | More hours than a day holds, even counting one unit per claim line | 36.8 | 67.2 | 44.8 | 63.1 | 1981 | 1 | 99203 99204 99213 99214 | $258K |
| Apr 2020 | More hours than a day holds, even counting one unit per claim line | 32.3 | 57.7 | 38.4 | 52.4 | 1785 | 1 | 99203 99204 99213 99214 99441 99442 | $217K |
| May 2020 | More hours than a day holds, even counting one unit per claim line | 42.9 | 67.5 | 45.0 | 66.5 | 2320 | 1 | 99203 99204 99213 99214 99441 99442 | $262K |
| Jun 2020 | More hours than a day holds, even counting one unit per claim line | 26.7 | 45.1 | 30.1 | 41.0 | 1578 | 1 | 99203 99204 99213 99214 99442 | $168K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | REX L MAHNENSMITH, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | December 5, 2005, last updated October 22, 2015 |
| Practice location | 80 PHOENIX AVE, Waterbury, CT 06702-1418, 203-756-8021 |
| Specialties | Internal Medicine, Nephrology (207RN0300X, license 021731 CT) Internal Medicine (207R00000X, primary, license 021731 CT) |
Procedures billed
The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $2.5M | 30% | $113 | $60 (top 5% from $133) | 91st percentile | |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $1.6M | 18% | $167 | $95 (top 5% from $171) | 94th percentile | |
| 95165 | Professional service for preparation and provision of 1 or more antigens | $1.5M | 18% | $1K | $187 (top 5% from $1K) | 96th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $1.3M | 15% | $74 | $44 (top 5% from $110) | 85th percentile | |
| 99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $600K | 7% | $100 | $67 (top 5% from $121) | 88th percentile | |
| 95004 | Test for allergy using allergenic extract | $200K | 2% | $185 | $136 (top 5% from $315) | 71st percentile | |
| 87426 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus | $141K | 2% | $34 | $32 (top 5% from $49) | 57th percentile | |
| 0241U | Respiratory infectious agent detection by rna for severe acute respiratory syndrome coronavirus 2 (covid 19), influenza a, influenza b, and respiratory syncytial virus, upper respiratory specimen, each reported as detected or not detected | $86K | 1% | $117 | $113 (top 5% from $189) | 53rd percentile |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 35 | 35 | $5K | $250 | $129 | 1.9x | 2.3x (90th percentile 4.1x) |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 45 | 27 | $4K | $350 | $130 | 2.7x | 2.3x (90th percentile 3.8x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 48 | 34 | $3K | $247 | $92 | 2.7x | 2.2x (90th percentile 3.8x) |
| G0444 | Annual depression screening, 5 to 15 minutes | 18 | 18 | $342 | $30 | $19 | 1.6x | 2.2x (90th percentile 3.8x) |
| 96127 | Assessment of emotional or behavioral problems | 22 | 13 | $65 | $40 | $5 | 8.1x | 3.7x (90th percentile 7.2x) |
A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.
In this area
30 providers in Waterbury, CT carry an indicator in the public record, with $12.6M at stake between them. The most common is part of a provider network, on 12 of them, followed by more hours than a day holds on 11. 4 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | KATRIN MOSKOWITZ Waterbury, CT, ranked 169 | $63K |
|
| 1 | ANATOLY BRAYLOVSKY Wallingford, CT, ranked 488 | $0 |
|
| 1 | FAMILY PRACTICE OF GREATER NEW HAVEN, LLC Wallingford, CT, ranked 514 | $0 |
|
| 1 | LP COUNSELING SERVICES, LLC North Haven, CT, ranked 673 | $0 |
|
| 3 | TOTALITY HOME HEALTH CARE AGENCY, LLC Milford, CT, ranked 779 | $2.3M |
|
| 3 | WHITNEY MANOR OPERATING COMPANY LLC Hamden, CT, ranked 1451 | $35K |
|
| 3 | ADVANCED CENTER FOR NURSING & REHABILITATION LLC New Haven, CT, ranked 1471 | $27K |
|
| 3 | NEW HAVEN CENTER FOR NURSING & REHABILITATION, LLC New Haven, CT, ranked 1479 | $24K |
|
Recent enforcement in CT
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
Referral packet
The packet is a draft for a reviewer. It reads every public record behind this case, states what the records show with a citation for each finding, names the regulation each finding relates to, and lists the ordinary explanations to rule out first. It never asserts intent.