Physician

Toni Sicenica, MD

According to 2025 Medicare claims, Toni Sicenica, MD (NPI: 1235123159) practices pulmonary disease in the Weirton-Steubenville, WV-OH market, with the plurality of this provider's patient population coming from Hancock, WV. This provider's primary affiliated billing organization is PITTSBURGH PULMONARY MEDICINE, PC (NPI: 1528352150; TIN: 452352801) and primary practice location at 26062-5014.

Sicenica's data goes back to 2015 and runs through 2024. For example, in 2024, this provider had 328 traditional Medicare patients, billed 1,542 HCPCS/CPT codes, and received $96,531 in Medicare payments. The top billing code was 99222 (Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes). Part D data shows 1,919 prescription claims across 278 beneficiaries totaling $725,983 in drug costs, led by Trelegy Ellipta (Fluticasone/Umeclidin/Vilanter). DME data shows 1,104 claims. Open Payments data shows 2 records totaling $214. You can download detailed data with all billing codes (2015-2024). For more recent data, please contact us.

Over the past 10 years, this provider's Medicare Part B carrier billing did not follow a clear longitudinal pattern. Concurrently, Part D prescription costs have moved sharply higher in recent years, from $98,000 to $725,983. For DME billing, reported payments moved from a lower plateau to a higher plateau, from $16,514 to $65,250.

Part B Carrier Billing Trend

Medicare payment trend, with N of patients and claim lines in the table.

Year	Patients	Clm Lines	Payment
2015	318	2,496	$153,920
2016	362	2,603	$149,807
2017	382	3,283	$186,034
2018	390	2,906	$152,631
2019	359	2,915	$179,560
2020	455	3,079	$195,396
2021	444	2,607	$163,999
2022	425	2,638	$163,387
2023	387	2,049	$148,819
2024	328	1,542	$96,531

Part D Events Trend

Drug cost trend, with N of patients and prescription claims in the table.

Year	Patients	Claims	Drug Cost
2015	102	616	$98,000
2016	127	665	$131,113
2017	131	626	$138,964
2018	132	621	$151,010
2019	146	728	$179,425
2020	159	929	$254,895
2021	205	1,115	$420,888
2022	236	1,433	$663,197
2023	253	1,681	$755,157
2024	278	1,919	$725,983

DME Billing Trend

Medicare payment trend, with N of patients and DME claim records in the table.

Year	Patients	Claims	Payment
2015	N/R	94	$5,977
2016	N/R	198	$6,136
2017	25	273	$8,181
2018	25	274	$23,194
2019	51	438	$39,991
2020	85	578	$45,365
2021	142	713	$47,412
2022	211	1,003	$61,874
2023	252	1,280	$77,138
2024	245	1,104	$64,531

* / # = suppressed by CMS; 0 = reported zero; N/R = not reported or blank.

Top 5 Part B carrier billing codes in 2024

By total payments.

Code	Description	Patients	Clm Lines	Total Payment
99222	Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	79	93	$82
99233	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	72	177	$80
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	90	123	$69
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	83	99	$58
99232	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	147	731	$53

Top 5 Part D drugs in 2024

By total drug costs.

Drug	Generic	Claims	Total Day Supply	Total Drug Cost
Trelegy Ellipta	Fluticasone/Umeclidin/Vilanter	374	15,180	$317,124
Fasenra Pen	Benralizumab	14	784	$80,108
Breztri Aerosphere	Budesonide/Glycopyr/Formoterol	81	2,670	$55,042
Breo Ellipta	Fluticasone/Vilanterol	93	3,810	$49,183
Stiolto Respimat	Tiotropium Br/Olodaterol Hcl	36	1,494	$22,484

Top 5 DME services in 2024

By Total Medicare Payment Amount.

HCPCS Code	HCPCS Description	Supplier Rental Indicator	Total Supplier Beneficiaries	Total Supplier Claims	Total Medicare Payment Amount
E0466	Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)	Y	N/R	30	$24,351
E1390	Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate	Y	37	246	$18,116
E1392	Portable oxygen concentrator, rental	Y	11	80	$2,513
A7031	Face mask interface, replacement for full face mask, each	N	14	41	$2,419
A7030	Full face mask used with positive airway pressure device, each	N	12	25	$2,011

Open Payments Summary in 2024

Category	Definition	Records	Total Reported Amount	Top Related Entity
General Payments	Reported payment or transfer-of-value amount.	2	$214	Inari Medical, Inc.
Research Payments	Reported research-related payment or transfer-of-value amount.	0	$0	N/R
Ownership / Investment Interests	Reported value of ownership or investment interests.	0	$0	N/R

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FAQ

What Medicare data is available for Toni Sicenica, MD?

Tedicare shows public-source Medicare data for Toni Sicenica, MD (NPI 1235123159), including provider identity, specialty, market context, Medicare Part B activity, Part D prescribing, DME records, Open Payments where available, billing organization details, and ACO affiliation signals where available. Profile data covers 2015-2024, with current attribution based on 2025 claims where available.

Does Toni Sicenica, MD have ACO affiliation data?

No ACO affiliation record is shown in the available Tedicare data for this profile.

What billing organization is linked to Toni Sicenica, MD?

Toni Sicenica, MD is linked to PITTSBURGH PULMONARY MEDICINE, PC (billing NPI 1528352150) in the available physician profile data.

Does Toni Sicenica, MD have Open Payments data?

Toni Sicenica, MD has 2 connected Open Payments records in the available 2024 summary data.

Can I download physician-level Medicare data from Tedicare?

Yes. Tedicare provides sample physician export data and paid custom physician data exports for research, planning, outreach, and market analysis. Exports can include physician profile fields, market and specialty context, billing organization details, ACO affiliation signals where available, and Medicare utilization data.