JAMES AVERY RUSH, M.D.
NPI 1992975841, individual, Amarillo, TX, Psychiatry & Neurology, Psychiatry
- Hours beyond a day in 2 months under one organization, which can be supervisory billing.
- Records needed.
- 75% of Medicaid dollars are on codes with a history of abuse.
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 |
|---|---|---|---|---|---|---|---|---|---|
| Apr 2021 | More hours than a day holds at a conservative unit price | 6.5 | 48.0 | 32.0 | 43.6 | 118 | 2 | 90791 90832 90833 90853 99205 99214 | $99K |
| May 2021 | More hours than a day holds at a conservative unit price | 5.1 | 39.4 | 26.3 | 38.8 | 72 | 2 | 90833 90853 99214 | $86K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JAMES AVERY RUSH, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | March 6, 2008, last updated November 2, 2022 |
| Practice location | 1901 MEDI PARK DR STE 2058, Amarillo, TX 79106-2109, 806-354-9540 |
| Specialties | Psychiatry & Neurology, Psychiatry (2084P0800X, primary, license M7583 TX) |
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 | |
|---|---|---|---|---|---|---|---|
| 90853 | Group psychotherapyhistory of abuse | $483K | 75% | $3K | $60 (top 5% from $332) | 100th percentile | |
| Q3014 | Telehealth originating site facility fee | $64K | 10% | $6.50 | $21 (top 5% from $84) | 21st percentile | |
| 90832 | Psychotherapy, 30 minutes | $36K | 6% | $366 | $59 (top 5% from $239) | 99th percentile | |
| 90833 | Psychotherapy with evaluation and management visit, 30 minutes | $31K | 5% | $92 | $49 (top 5% from $109) | 91st percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $11K | 2% | $67 | $60 (top 5% from $133) | 58th percentile | |
| 90791 | Psychiatric diagnostic evaluation | $9K | 1% | $127 | $105 (top 5% from $228) | too few months to rank | |
| 90887 | Medicaid service code | $6K | 1% | $68 | $98 (top 5% from $270) | too few months to rank | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $3K | 0% | $100 | $96 (top 5% from $249) | too few months to rank |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| G2083 | Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, | 652 | 20 | $583K | $2K | $1K | 2.1x | 1.8x (90th percentile 3.7x) |
| 90832 | Psychotherapy, 30 minutes | 643 | 21 | $39K | $125 | $76 | 1.6x | 2.0x (90th percentile 3.5x) |
| 90837 | Psychotherapy, 1 hour | 50 | 11 | $6K | $290 | $145 | 2.0x | 1.6x (90th percentile 2.9x) |
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
6 providers in Potter County, TX carry an indicator in the public record, with $464K at stake between them. The most common is part of a provider network, on 4 of them, followed by more hours than a day holds on 2.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | HIGH PLAINS SENIOR CARE, LLC Amarillo, TX, ranked 1377 | $79K |
|
| 3 | STATE OF TEXAS VETERANS LAND BOARD Amarillo, TX, ranked 2083 | $0 |
|
| 3 | HEALTHCARE OF WEST TEXAS LLC Amarillo, TX, ranked 2391 | $0 |
|
| 3 | A P HEALTH AND PALLIATIVE CARE, LLC Amarillo, TX, ranked 2966 | $0 |
|
| 4 | CLAIRE BRADLEY Amarillo, TX, ranked 9322 | $342K |
|
| 5 | GEORJANE WOODBURN Amarillo, TX, ranked 11780 | $43K |
Recent enforcement in TX
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.